SigmaSRNA

..and with that, the death of the all MDA/DOA model. "One often finds the path to destruction on his way to try to avoid it" - Kung Fu Panda.

I have a question: How many AAs are in CRNA school in Michigan?

My beef isn't with AAs specifically (meaning if you can do anesthesia and properly trained then you should be able to make a living out of it). My problem is the reason there is such a big push NOW by the ASA to promote the AA profession. When CRNAs weren't as free in the 80s and early 90s you barely even heard of an AA ( the reason that there's only 4 or 5 schools in 30 damn years). Why didn't the ASA pump up the AA profession then????Why now. Shortage huh? More like control and money. The TSA (Texas Society of Anesthesiologists) are trying to, on one hand, question the safety record of CRNAs plus trying to tighten our practice, and on the other, promoting the AA profession and even going so far as to say they can work in a 1:4 ratio. Doesn't make sense to me to promote safety and promote AAs (not saying AAs are unsafe). Just saying that they want AAs to practice like the very profession that's unsafe in their eyes(CRNAs).

I'll agree with half of what you are saying. I'm doing my clinicals in a county hospital in southern california and the job market for CRNAs in southern california sucks. As far as RNs and the state of california, the california nurses association is probably a close second to the mafia as far as pull and power in legislature. I have never seen the overtime laws in any other state that they have here in cali. An RN making in the 6 figures is not uncommon. Plus, hospitals can easily get reported if RNs don't get the breaks they are supposed to or work too much. Not bad for a minimum of an associate's degree.

Is there a regulatory board at the state level for AAs?

80 - 85% of Texas Counties don't have hospitals? Ignorance in its highest form. You must be refering to Georgia counties with that number man. CRNAs are flocking to rural america alot faster than MDAs are and that is the basis of the argument. Basically, its not about being gung ho to do anything. Its about our committment to providing that access that is needed (and will be needed in greater numbers as the years goes on) And who is talking about a damn Open Heart or NICU anyway? I'm talking about the emergent appy, The MVAs, the meth explosion 100 miles outside of Dallas, the "damn, my wife caught me with my best friend and stabbed the s*** out of me". That's what I'm talking about. If you want to talk about money, I'll be able to work in all 50 states and the U.S. territories. Play your role ..........assistant.

Interesting point and I can see that perspective. I'll say this; Lets try to do a study comparing the outcomes of CRNAs and AAs in rural settings or settings outside of an anesthesia care team model. OH Wait!! That can't happen because AAs can't work outside of an ACT model and the supervision rules and lack of MDAs in the rural setting prevents them to work in such. That's the problem with healthcare. ACCESS!!!. 80 to 85% of the counties in Texas don't have an MDA working in them. So how the hell is an AA going to help?? Another way to think about it. In the setting of a big city, big anesthesia group, shrinking healthcare dollars. AAs/CRNAs cheaper alternative and in an ACT, same results of an MDA. AAs won't just take up CRNA jobs; MDAs won't exactly be sitting pretty either (especially those coming out of residency). Its already happening in big hospitals in Dallas. 6 years ago you couldn't find a job in Dallas. Now they are all over the place. At least for CRNAs

Please don't label me as a sellout for asking this question because I love what I'm training to become but, where exactly do we want the MDAs to be? If they are in our O.R. room all the time, we say they are controlling. If they kick it in the lounge and let us do our thing, we call them lazy. So where do we want them?

I'm all for education and I think that the DNP is a good idea as long as its not made the entry into practice (an option) or at least not until the shortage of anesthesia providers is curtailed a bit. Can you imagine the recruiting pitch AAs schools will have in recruiting a fresh crop of ICU RNS!!!! ( Why go to school for 3 1/2 years when you can go for 2 1/2 and make the same money!!!) In hospitals that use both CRNAs and AAs the pay is exactly the same relative to experience (atlanta, ohio, south carolina, florida for examples). There are going to be alot of ICU nurses (at least in these states) who will be thinking twice about an extra year of school (which could cost them more than 120K not including the extra debt they would have)to pretty much do the same job. Hence the # of CRNAs could potential drop (especially with alot of older CRNAs retiring). The timing of this is just bad.

To get that answer without getting a 80 page blog you should probably do a search on this topic. You should get alot of information for what you seek that way because its been discuss on this board ALOT! This probably won't stop the bloodshed (excuse me, healthy debate) but I had to try.

Wow. Interesting. Here is another perspective. I'm a black male SRNA/RRNA presently at Texas Wesleyan Univ Class of 2007. We have a total of 7 black people currently in my class and more than 5 or 6 in the class behind mine (most of them I'm friends with). We have other races represented but I don't know the numbers so I will just focus on my african american counterparts. As far as why there isn't alot of African Americans (AAs) in CRNA School I can only theorize; and that theory would be the following: We are a small percentage of nursing in the first place. Within AAs in nursing there is even a smaller percentage working ICU. Breaking it down even further, a small percent apply to grad school IN GENERAL, so to have 6 other black people in a class of 128, I was GRATEFUL. TWU is unique in that the requirements to get entry is not as rigid as most schools around the country. They really look at more than a GPA (even though they are getting a little harder with that because some people can't get past " THE R!!" :-). This was my case. I had a 2.5 overall and a 1210 on the GRE (my saving grace). This just simply got me an interview based on the standards of that time (which have since gotten more rigid). Then they saw me and accepted me. Since starting school I've only made one B (Cardiopulmonary Phys which was an absolute beast) and the rest As. I guess my point is that they gave a young black man with a crappy GPA a chance because they saw potential when they got to know me. Very few schools in the country would have done that. That's why I'm personally trying to recruit AAs to come to this school because I know the staff, I know why DR. R is the way he is (and I'm grateful), and you will get a great education. How do I know that? Okay. I'm currently at Arrowhead Regional Medical Center in California and we have 3 different anesthesia programs come here. TWU/TCU, Kaiser, and USC. Most of the staff CRNAs are from california having went to Kaiser and USC and constantly tell us (TWU/TCU) how far ahead of the game we are in comparison. Considering that 10 to 12% of the CRNAs in the entire country trained at TWU, it speaks for itself. I'm not discounted what the previous poster wrote; I can just tell you about the experience of 13 African Americans RRNAs currently in the program and its vastly different.

For all the providers familiar with atlanta, what hospitals allow crnas/aas to place spinals/epidurals for OB???

Who likes to use air and who uses saline? If you do use air, have you ever had a patient with pneumocephalus?

For everybody who's given anesthesia so far; How many of you use lidocaine near the time of extubation and if you do, what dose and about when do you give it. My CRNA on thursday gave 40mg about 5 mins or so before the patient was extubated. It worked pretty well but I just wanted to hear some other providers experience.

I know of the school in which the poster is speaking and have heard from a couple of people from that program that they are having a pretty rough summer. There is a line between sucking it up and not receiving what you need to do well on the test (poorly written questions and such). I'll leave it at that.

There is one thing to consider here. Even if they make this law (which it isn't) it will only effect those that are going to be CRNA at or around 2015. If you will have a master's before then, you don't have to go back unless you want to be a program director. I was told at the Texas Association of Nurse Anesthetists conference in march that you can still teach with a PhD in any subject. You just can't be the director or asst. director. Just adjunct faculty. Plus, there are plenty of CRNAs with certificates so its not about the degree.

The class is alot of money (as all of you probably know). Is the actual classroom that helpful to where missing it would cut my chances of passing boards significantly? If I study the sweat book diligently would that work? Any recent anesthesia school grads who've taken boards would be a big help.

'Very true. 99% of the decisions are made by the docs/residents in the ER. But at least you get the exposure of seeing the ABCs (and especially ACLS/PALS protocols) in the ER (evening if your not making the call). Also, in the ICU, wants you see a patient needs a tube, your going to call somebody to put it in. The only reason you don't do the same in the ER is a doc is always there. Not the case in the ICU. Like I said before, as far as patho/pharm, no one touches an ICU nurse, but ER experience can be valuable also (not so much better). Just finished my first year at Texas Wesleyan (Fall 07). What about yourself?

That is fair. Very True

Okay, I'll say this. How many times have you had to worry about Airway, Breathing, and Circulation (PRIMARY SURVEY) in a level one ER vs. the busiest trauma ICU. In the ER, as you well know, the primary survey takes place. So why would the ICU be better for this than the ER? I've seen more tubes go in patients in the ER than the ICU (where MOST, not all, of the time the tubes are already in place). As far as the use of airway adjuncts, the manipulation of an airway (the alcoholic patient or the child with croup) or conscious sedation gone wild, you see all this in the ER, so why would the ICU be better as far as the ABCs? That was my argument. As far as decision making, I agree ICU might be better but that's another topic.

Okay. For those SRNAs who are either in or going to clinicals, do you know where I can get a brain book OR what to put in a brain book. Thanks in advance.

Another point I thought I should mention: When it comes to the ABCs, nothing gets you ready better than a HIGH ACUITY Level 1 ER/Trauma Unit. NOTHING!!! As far as the pharm/physio aspect of it all, its all about ICU. Maybe schools should require a year of both. (can feel the hate from that last statement).

Not to add flame to the debate (but I know I probably am) but I would agree that ER is more challenging if it wasn't for the fact that most ERs in america are more primary care clinics and not on the level of a Charity, Grady, or Parkland. If every ER in the US was a level 1 you all would have a point. Having worked both (mostly military settings), I give the nod to ICU. For the poster: Some schools will take you with ER experience and with ICU experience (and the grades and test scores) you can be a very strong, well-rounded candidate.

I appreciate what you had to say brian but I don't have a family and the program has already started for me. I didn't quite understand what you were trying to say and how it related to going from classroom to clinical.

I appreciate that Ami. I'm just really nervous about actually applying theory to practice. Its still very surreal to me. I'm glad to see that there are some people that struggled a little at the start.