Scope of Practice

skipaway · Mar 8, 2008

Of course you haven't seen any evidence to curtail these course offerings since you are not either a program director or course director.

How do you know what my current situation is?

n_g · Mar 8, 2008

http://www.lasvegassun.com/blogs/news/2008/mar/05/nurses-surrender-licenses/

The Nevada State Board of Nursing reports that

five certified nurse anesthetists

voluntarily surrendered their licenses Wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at Endoscopy Center of Nevada, which led to the largest hepatitis C scare in the nation.

Why do posters on here wonder why there is such a high bar when it comes to patient safety? Did the patient who was paralyzed by the unsupervised CRNA who was doing interventional pain know that he/she only had 2 weekend courses on pain? To say that a pain doc could have done the same thing is so laughable. That's like saying that if a CRNA does surgery and kills someone is no big deal because a board-certified surgeon could have done the same thing too. If the potential for injury or death is there, then few patients would want some marginally trained person performing anything on them. They want someone who has been fully trained and certified by accredited programs. How many patients want to be guinea pigs for some CRNA who has just received 2 weekend courses? I think that all the defenders of CRNA's doing pain should be those guinea pigs.

The courts ruled the way they did because they saw through the half-truths that the AANA puts out. Unlike politicians, courts can't be bought off. If you want to convince them, bring your evidence and arguments. Like I keep saying, step up to the plate.

n_g · Mar 8, 2008

Oh look it is issued by the state, I too am a licensed medical professional.

Oh, are you a licensed medical professional? Or are you a licensed nursing professional? Because pain is "solely the practice of medicine" according to Louisiana. If you want to be licensed medical professional who falls under medicine, then petition the AANA to make that change.

Home Health Columnist / Guide · Mar 8, 2008

http://www.lasvegassun.com/blogs/news/2008/mar/05/nurses-surrender-licenses/
the nevada state board of nursing reports that
five certified nurse anesthetists
voluntarily surrendered their licenses wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at endoscopy center of nevada, which led to the largest hepatitis c scare in the nation.

sampling educational efforts:

2002: aana - 111302 -- reuse of needles and syringes by healthcare ...

2005: syringe reuse transmits infection the article noted the aana initiative and stated, “cdc is working with professional ... control practices related to syringe and needle reuse were needed. ...

www.apsf.org/resource_center/newsletter/2005/summer/10syringe.htm

2008: aana - 022908 -- aana response to hepatitis c outbreak in nevada

2008: [color=#0000cc]a patient safety threat - syringe reuse - fact sheet | cdc ...

state boards can request voluntary surrender of license until investigations are complete if part of state practice acts. when one's own individual actions violate professional standards or board regulations, revocation of license is always the penalty across all professions.

same for these professionals:

[color=#0000cc]doctor caught reusing syringes - northern virginia personal injury ...

[color=#0000cc]doctor accused of reusing syringe - health news story - wmor tampa

another long island doctor commits malpractice by reusing syringes

an outbreak of hepatitis c virus infections among outpatients at a hematology/oncology clinic

[color=#336699]doctor heading clinic with hepatitis case has stopped practicing medicine the nevada state board of medical examiners just announced that dr. dipak k. desai, owner of the endoscopy center of southern nevada where six cases ...

n_g · Mar 8, 2008

Let me get this straight, if someone had a surgical rotation regardless of the duration or how long ago as long as they have MD they are good to go for invasive procedures?

Doing invasive procedures is more than simply performing the procedure. It's also knowing the indications, best treatments, and managing them post-procedure. Do you think that there are no consequences to cutting people open? Things like infections? Don't worry, invasive procedures are not within the scope of nursing. As part of their training, FP and internists learn how to manage these types of patients. The fallacy in your logic is that you think that a CRNA and a primary care are at the same level when they learn some of these basic pain techniques. A primary care is leaps ahead of a CRNA in diagnosis, indications, treatment, and management. A CRNA learns how to deliver anesthesia in CRNA school and not the above. If you read the arguments in the case, the differences in education between a physician and CRNA were entered into evidence and became a factor in the final judgment.

stanman1968 · Mar 8, 2008

As pointed out every type of health professional has had this kind of problem before, and why are you changing the subject?

When we point out that the injections are being taught over a weekend to us you call it unsafe. When it is pointed out that these procedures and more invasive ones are being taught to physicians over weekends we get well we do not approve, When pointed out that it is the professional pain associations performing these seminars it turns to well they have a surgical rotation, given that logic a quick weekend course and they should do CABG. You then say we will run risks of being independent practitioners blithely unaware we are already independent practitioners. And finally you bring up the actions of a few careless practitioners and attempt to make the whole out as unsafe, I guess you were unaware of the multiple infections caused by reuse of syringes and needles by MD practitioners. Given your concern over public safety and a record of unsafe MD practice perhaps they should not be practicing after all look what they do.

With every post it has become more and more obvious that you are untrained /uneducated, or just willfully ignorant of medicine, anesthesia the education process for CRNA's and a multitude of other related topics. One thing is clear though that you can spout a party line with the best of them, please go to SDN the great echo chamber of pain and anesthesia. You will fit right in no independent opinions are required just the ability to regurgitate the party line regardless of evidence. I think you have demonstrated YOUR qualifications on this very well indeed.

stanman1968 · Mar 8, 2008

Good for louisiana not the case in indiana, and to say bad outcomes cannot occur to doctors doing the same procedure as a CRNA shows an absolute ignorence of medicine and anesthesia. Please tell me what is the incidence spinal hematoma in sab or epidural hematoma in epidural placement?

Done any research on outcomes between providers? The arguments you espouse have been used to try to prevent CRNA's to perform regional anesthesia place lines, use a flouroscope etc, etc.

They have been shown false everytime. Please if you want to discuss the issue rationally then educate tourself on CRNA education skills and practice, quit spouting the party line and THINK use that muscle between your ears, it is the strongest one you will ever have.

Home Health Columnist / Guide · Mar 8, 2008

. as part of their training, fp and internists learn how to manage these types of patients. the fallacy in your logic is that you think that a crna and a primary care are at the same level when they learn some of these basic pain techniques. a primary care is leaps ahead of a crna in diagnosis, indications, treatment, and management.

2003: students need more pain management training: education effort ...

washington -- medical students aren't getting adequate training to address pain problems that afflict more than 75 million americans.

that's what health officials and medical school representatives said at a press conference sponsored by the american academy of pain medicine (aapm), in launching a new "virtual textbook" that students can use on their own time to learn about pain diagnosis and treatment.

only 3% of medical schools have a separate required course on pain management, and 4% require a course on end-of-life care, according to statistics from the association of american medical colleges (aamc).

less than a third of schools offer elective courses in pain management, and only a quarter provide electives in end-of-life care.

"if we are to effectively treat a future generation of pain patients, we first must educate the next generation of doctors who will care for them," said dr. jordan cohen, aamc president.

the concept of a virtual textbook "is very appealing and has the potential for broad usage," dr. deborah mcpherson, assistant director for medical education with the american academy of family physicians, told this newspaper. but she questioned whether students would find time in their busy schedules to do this type of supplemental work. "the reason why we're not teaching appropriate pain management is because there's just not enough room in [current] curriculums," dr. mcpherson said.

medical education a barrier to pain therapy and palliative care. journal of pain and symptom management, volume 21,

issue 5, pages 360-362

[color=#660000]

state continuing medical education policies for pain and palliative care

most state medical boards require continuing medical education (cme) for physicians to renew their license. recently, legislatures and state regulatory boards have begun to

require or encourage that cme include education on pain management or palliative care for all or some licensees to provide physicians with updated medical, scientific and clinical knowledge. evidence that many physicians lack knowledge about pain management and received little training in medical school suggests that such policies are needed and may be a positive step toward improving pain management. emphasis should be placed on the quality of the curriculum and teaching methods. these policy initiatives should be viewed as experiments until evaluations demonstrate their value.

aana:

education of nurse anesthetists in the united states

nurse anesthesia program curriculum
the didactic curricula of nurse anesthesia programs are governed by coa standards and provide students the scientific, clinical, and professional foundation upon which to build sound and safe clinical practice. most nurse anesthesia programs range from 45 to 75 graduate semester credits in courses pertinent to the practice of anesthesia. the science curriculum of graduate nurse anesthesia programs includes a minimum of 30 semester credit hours of courses in anatomy, physiology, pathophysiology, pharmacology, chemistry, biochemistry, and physics. courses in anesthesia practice provide content such as induction, maintenance, and emergence from anesthesia; airway management; anesthesia pharmacology; and anesthesia for special patient populations such as obstetrics, geriatrics, and pediatrics. students are instructed in the use of anesthesia machines and other related biomedical monitoring equipment and are evaluated didactically using such traditional evaluation methods as examinations, presentations, and papers. patient anesthesia simulators are an emerging technology used in many programs to develop dexterity and critical thinking skills essential for the practice of nurse anesthesia.
the supervised clinical residency of nurse anesthesia education provides students the opportunity to incorporate didactic anesthesia education into the clinical setting. nurse anesthetists are prepared to administer all types of anesthesia, including general, regional, selected local and conscious sedation, to patients of all ages for all types of surgeries. they are taught to use all currently available anesthesia drugs, to manage fluid and blood replacement therapy, and to interpret data from sophisticated monitoring devices. other clinical responsibilities include the insertion of invasive catheters, the recognition and correction of complications that occur during the course of an anesthetic, the provision of airway and ventilatory support during resuscitation, and pain management.
to meet coa standards and be eligible to take the council on certification of nurse anesthetists (ccna) certification exam, a student must have performed a minimum of 450 anesthetics, which must include specialties such as pediatric, obstetric, cardiothoracic, and neurosurgical anesthesia. this anesthesia experience includes the care of not only healthy but also critically ill patients of all ages for elective and emergency procedures. in most programs, this minimum is surpassed early in their clinical practicum and the average number of anesthetics performed upon graduation is 773. the results of a 1998 survey of program directors show that nurse anesthesia programs provide an average of 1595 hours of clinical experience for each student.
during their clinical anesthesia experience, students are supervised by crnas or anesthesiologists who provide instruction in the safe administration and monitoring of various techniques, including both general and regional anesthesia. the clinical faculty also evaluate the technical and critical thinking skills of students on a regular basis.

n_g · Mar 8, 2008

2003: students need more pain management training: education effort ...
washington -- medical students aren't getting adequate training to address pain problems that afflict more than 75 million americans.
that's what health officials and medical school representatives said at a press conference sponsored by the american academy of pain medicine (aapm), in launching a new "virtual textbook" that students can use on their own time to learn about pain diagnosis and treatment.
only 3% of medical schools have a separate required course on pain management, and 4% require a course on end-of-life care, according to statistics from the association of american medical colleges (aamc).
less than a third of schools offer elective courses in pain management, and only a quarter provide electives in end-of-life care.
"if we are to effectively treat a future generation of pain patients, we first must educate the next generation of doctors who will care for them," said dr. jordan cohen, aamc president.
the concept of a virtual textbook "is very appealing and has the potential for broad usage," dr. deborah mcpherson, assistant director for medical education with the american academy of family physicians, told this newspaper. but she questioned whether students would find time in their busy schedules to do this type of supplemental work. "the reason why we're not teaching appropriate pain management is because there's just not enough room in [current] curriculums," dr. mcpherson said.
medical education a barrier to pain therapy and palliative care. journal of pain and symptom management, volume 21,
issue 5, pages 360-362
[color=#660000]
state continuing medical education policies for pain and palliative care
most state medical boards require continuing medical education (cme) for physicians to renew their license. recently, legislatures and state regulatory boards have begun to
require or encourage that cme include education on pain management or palliative care for all or some licensees to provide physicians with updated medical, scientific and clinical knowledge. evidence that many physicians lack knowledge about pain management and received little training in medical school suggests that such policies are needed and may be a positive step toward improving pain management. emphasis should be placed on the quality of the curriculum and teaching methods. these policy initiatives should be viewed as experiments until evaluations demonstrate their value.
aana:
education of nurse anesthetists in the united states

uh, we're talking about board-certified physicians who have finished their residencies, not medical students. specifically, these are pain medicine specialists who have also completed a fellowship after residency. :icon_roll

do you guys still wonder why crna's lost every court case involving pain and why the la legislature refused to pass a bill allowing crna's to do pain? this is the best evidence and arguments you can come up with? :yawn:

allnurses Guide · Mar 9, 2008

http://www.lasvegassun.com/blogs/news/2008/mar/05/nurses-surrender-licenses/
The Nevada State Board of Nursing reports that
five certified nurse anesthetists
voluntarily surrendered their licenses Wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at Endoscopy Center of Nevada, which led to the largest hepatitis C scare in the nation.

People do stupid things and make mistakes no matter what their level of training. Here is just a few MDAs making stupid mistakes....

http://www.nctimes.com/articles/2004/03/19/news/top_stories/3_18_0421_51_22.txt

Anesthesiologist charged by Medical Board

http://the.honoluluadvertiser.com/article/2002/Sep/21/ln/ln10a.html

A Honolulu anesthesiologist charged this week with purchasing chemicals that could be used to make the "date rape drug"

Failure to diagnose results in a judgment of $4.0 million when an anesthesiologist does not recognize that a patient has a small bowel obstruction.

Failure to get informed consent results in a judgment of $1.5 million after an interscalene block, for post operative pain control from torn rotator cuff surgery, placed against the patient's express wishes, resulted in severe neck pain, arm weakness, numbness and a drooping left eyelid. The defendant anesthesiologist claimed that the patient consented.

Failure to review a medication list results in a judgment of $700,000 when a patient taking a NSAID developed a post operative spinal cord hematoma with residual weakness in both legs and no bowel or bladder control after lumbar laminectomy surgery. The anesthesiologist's argument that it was not a breach of the standard of care to not read the medical record prior to surgery and that the anesthesiologist had no duty to discuss the drug with the surgeon was not accepted by the jury (Barbour v. Betz, June 2004).

Failure to do a "time out," followed by wrong sided knee surgery results in a judgment of $ 175,000 with 5% of the negligence assigned to the anesthesiologist

Failure in OR communication results in a judgment of $1.75 million when information about a change in intraoperative evoked potentials was not "heard" by the surgeon and a young women undergoing scoliosis surgery woke up partially paralyzed. The technician monitoring the evoked potentials claimed that he had informed the surgeon; the surgeon denied receiving the information. A later change in evoked potentials was ignored because it was attributed to anesthesia (Skaggs v Tupper, February 2005). It is unclear from the material available for review if the anesthesiologist was a defendant

Failure to record vital signs results in a judgment of $750,000 after cardiac arrest and anoxic brain damage to 48 year old man who had presented for elective debridement of the third finger of his left hand. Induction of general anesthesia and placement of a laryngeal mask airway were uneventful. Shortly after surgery began the patient became bradycardic and suffered a cardiac arrest. For one hour there was no recording of oxygen saturation on the anesthesia record. The anesthesia resident's claim that, despite the lack of recorded values, the patient had been continually monitored and given the appropriate amount of oxygen apparently did not impress the court (case citation withheld from article).

http://upennanesthesiology.typepad.com/upenn_anesthesiology/2007/08/recent-medical-.html

Thio is an anesthesiologist and pain management physician who had offices in Murrieta and Corona, said attorney Craig Johnson, who represented the plaintiffs.

"The act of billing fraud is viewed by the medical community as one of the most reprehensible acts," Johnson said

http://www.nctimes.com/articles/2004/01/14/news/californian/1_13_0422_42_47.txt

allnurses Guide · Mar 9, 2008

Uh, we're talking about board-certified physicians who have finished their residencies, not medical students. Specifically, these are pain medicine specialists who have also completed a fellowship after residency. :icon_roll
Do you guys still wonder why CRNA's lost every court case involving pain and why the LA legislature refused to pass a bill allowing CRNA's to do pain? This is the best evidence and arguments you can come up with?

Actually, we are talking about scope of practice, and the practice of pain management is not limited to board certified/residency trained physicians in pain management. It is open to any physician that wants to be a "weekend warrior" and open a pain clinic. So, if they didn't get their training in medical school...then where did these physicians get their training other than these notorious weekend courses.

The La court case is all about politics....no research has been done by either side.

AGAIN....YOUR QUALIFICATIONS ARE? (I just put it in capital letters this time since you must have a hard time seeing it all the other times it was posted on here.)

Home Health Columnist / Guide · Mar 9, 2008

Uh, we're talking about board-certified physicians who have finished their residencies, not medical students. Specifically, these are pain medicine specialists who have also completed a fellowship after residency. :icon_roll

95 % pain management is provided by family MDs and surgeons in everday practice. Prrior posts stated FP's have more education than CRNA"s in pain mgmt.... the above links from brief 5 min search prove otherwise.

Issue stated is scope of practice standards for CRNA profession INCLUDES pain managment education as part of basic education....more indepth training and education available for those that choose that role and interest.