squinkybear1

I wish I had the time to reply to you, Mike. But I don't really care to get into an on-line argument, given that I'm a "frustrated CRNA from Texas" and you're a doctoral candidate in neuroscience and all. I can see that you're way smarter and better informed than I. So I'll just terminate my connection to this chat subject now and curl up into a corner and feel inferior to you. NOT. Catch cha later, dude. CHILL!

I wish I had the time to reply to you, Mike. But I don't really care to get into an on-line argument, given that I'm a "frustrated CRNA from Texas" and you're a doctoral candidate in neuroscience and all. I can see that you're way smarter and better informed than I. So I'll just terminate my connection to this chat subject now and curl up into a corner and feel inferior to you. NOT. Catch cha later, dude. CHILL!

The ASA "rules" are not legislation. They only suggest the relationship of the CRNA with the ologist as THEY define it. They are not necessarily consistent with practice laws and/or reality.

Some CRNA/ologist relationships are collaborative. Some are concerned with maintaining the hierarchy. So, even in states where CRNA's have independent practices, the head of the anesthesia department might require that an ologist be in attendance when an anesthetist intubates, for example. That same CRNA can bill independently for his or her services, but may continue to do most of the anesthesia administration, on the majority of the cases, under the direction of the ologists. Also, depending on the facility, the CRNA may or may not be able to order meds for patients while in the PACU! It all depends on the department protocols and procedures that, in many places, the anesthesiologists continue to control. So, independent practice may extend to the billing process only and not be very apparent in the day-to-day operation of the department or elevate the status of the CRNA within the structure of the facility. On the other hand, in areas where anesthesiologists are absent, (rural, poor, underserved parts of the country), CRNA's do EVERYTHING. They practice independently and bill independently, as well. Depends on where you choose to practice. Some states are challenging the independent practice of CRNA's. Texas is cooking up some new legislation to take away the independent practice of CRNA's and they have already accomodated Anesthesiology Assistants in the practice laws. Such moves toward a greater number of A. Assistant programs and a trend toward the acceptance and use of A. Assistants by the medical community, probably plays a role in the AANA's consideration of raising the basic level of ed for the CRNA. As it stands, the A.A. programs are rigorous and require prereqs that resemble premed curriculae. There are only a couple of programs, however, that are exclusively designed to train Anesthesiology Assitants. The programs require about the same time commitment (after prereq and/or bachelors degree are satisfied) as the CRNA programs: 28-33 months. Prereqs are heavier in physics, organic and math. Even with a doctorate, the states will continue to determine whether or not a CRNA practices independently. A doctorate does not quarantee independence. It seems like it's a costly degree, in terms of bucks and time spent without an income. Practically speaking, it may be a hard sell to those of us who need to get to work and generate income so that we can take care of our families. As far as the doctoral programs are concerned: it's my understanding that you are eligible to participate in a COA-approved doctoral program as long as you have earned any masters degree required to qualify to sit for the credentialing exam to become a Certified Registered Nurse Anesthetist. That would include all the MS degrees that are granted in programs currently approved by the COA. They include the MS (Health Science, Biology, Medical Scinece, etc.), MSN, MSNA. Not all approved programs offer a "nursing" designated masters degree.

Research is a case for the doctorate. But, maybe all nurses, whether diploma or DNSc degree holders, should be required to perform X hours of direct patient care per year and continue participation in patient-focused research in order to maintain their licenses. Nursing is not a science. It is an art that incorporates science and research. The doctorate might be seen as being more political than practical, allowing membership into an exclusive (not inclusive) club. As nurses we need more cooperation. Also, who is going to offer the fellowship monies to see thousands of nurses through doctoral programs and who is going to convince the public that a nurse with a doctorate is still the nurse that they perceive a nurse to be? My chosen doctoral program costs over $100,000 in tuition. Am I nuts? I'll be paying for my master's degree until I'm 70 years old. That hasn't elevated my salary or my credibility. My skills and my clinical experience speak volumes that a few letters behind my name could never match.

Think twice before choosing Wesleyan. Substandard instruction. Weird scene. Too many students. No university accountability, no school dean- only director and 2 other people for over 120 students. A&P instructor administers exams that would not pass any validity and reliability test for the ETS or APA and they are definitely not open to ANY observations or criticisms. You will be punished if you do not submit. Third Reich of CRNA schools.

It's not a matter of pay or territorial rights. It's an ethical and quality of care issue. Nobody but the anesthesiologist assistants are going to be successful in invading CRNA territory. It's inevitable. I digress. Nursing education is seriously lacking, as well as is the practice of standards of care in a facility that would give any RN, regardless of experience or training, the responsibility for the well-being of a patient who is anesthetized. Period. I don't believe that there exists a nurse practice law, within the USA, that gives this particular responsibility to the scope of practice of an RN with the basic, (and seriously deficient) NLN Accreditation Council-approved, two-year- devoid of clinical experience-education. When both lack of basic education in pharmacokinetics/dynamics and lack of clinical skill are joined with a careless management team that will risk the life of a patient in order to save a few bucks, nothing can be gained. It's pretty aggregious. (Did I spell that OK?). A RN who takes on responsibilities for which she/he is neither trained nor prepared for academically or clinically, is jeopardizing her/his patients and her/his career, not to mention- enabling risky behavior and ensuring that dangerous practice continue and patient injury result. Propofol has a reputation of being a benign agent. It's a great drug with a short duration of action, normally. However, I have had to bag patients and request re-intubation of patients in the PACU after they have undergone simple ortho procedures, when induced and intubated on Propofol, 2.0mg/kg, maintained on Propofol for a 45min-1hour procedure, & having had received no more than Fentanyl 50mcg & Versed 1mg at the beginning of the case. Redheads seem to need a bigger bolus for effect, but do not emerge well. And some people just have ideopathic responses to everything, no matter how "benign". THERE'S NO REVERSAL AGENT FOR THOSE WHO EXPERIENCE AN IDEOPATHIC RESPONSE: NEUROGENIC EXCITABILITY, POST-EXTUBATION APNEA OR HEMODYNAMIC INSTABILITY! Pediatric use of Propofol is not recommended these days because of resultant seizures, hemodynamic instability and apnea which have resulted in brain injury and death. 1. If you are a registered nurse, you should refuse to go beyond your scope of practice. You are not trained or certified to monitor and/or respond to the physiologic changes of a patient who is anesthetized. If you have to use your ACLS skills, (the only skills that you may actually need to use) it's too late for the patient. 2. You should possess the critical thinking skills and the professionalism to say, "NO" to physicians and managers who are willing to sacrifice standards and your license, for the sake of convenience. If you have any doubt, refer to your nurse practice laws and to the standards of care of the anesthetized patient. Care of the anesthetized patient requires specialized education and training far beyond that provided to pass the NCLEX. What do you think?