Scope of Practice

deepz · Mar 1, 2008

Wow. All the usual suspects engage in more nurse bashing and outright lies.

I'm shocked -- shocked I tell you.

Qwiigley, BSN, MSN, DNP, RN, CRNA · Mar 1, 2008

I doubt any hospital or insurance company is going to allow a CRNA to practice certain things such as "bring a patient to radiology or the OR/.. make a lumbar cuts into a patients back, placing spinal leads for pain stimulators using C-arm, placing Baclacin Pumps (sp?) into patients etc. etc" I was not trained to do any of this, but I only went to one school and am not specifically aware of other's training. As far as I know, CRNAs have not been trained for these procedures.

I do feel we have a place in clinics doing what we are experts in, though. I also support the progression of education as well as the same requirements are applied to both the CRNAs and the FP docs. Weekend course, I dont think anyone is disagreeing with you on that for either group.

paindoc · Mar 2, 2008

Oh, you underestimate the avarice of the hospitals and the overconfidence of the weekend warrior trained CRNAs. It is already happening in several states. It is a repugnant practice that is an insult to the vast majority of CRNAs that value patient safety and appropriate education to insure optimal outcomes.

allnurses Guide · Mar 2, 2008

Oh, you underestimate the avarice of the hospitals and the overconfidence of the weekend warrior trained CRNAs. It is already happening in several states. It is a repugnant practice that is an insult to the vast majority of CRNAs that value patient safety and appropriate education to insure optimal outcomes.

Paindoc your rhetoric about weekend courses/"weekend warriors" being the only training that CRNAs practicing chronic pain management is starting to sound like a broken record. You have absolutely no proof that this is their only training! It is just the typical rhetoric of AMA/ASA to defend their case against CRNAs doing chronic pain management... absolutely no proof but it sounds compelling for the uninitiated into the political doings of the AMA/ASA. The same goes for educational differences between physicians and CRNAs doing chronic pain management no one has any proof that it makes any difference in patient outcomes, but it sounds good for your case to keep pointing out the educational differences. The same arguement is used against CRNAs and independent practice, but the big difference there is that there is plenty of research showing CRNAs perform just as well as MDAs in independent anesthesia practice. It wouldn't matter to the AMA/ASA, or probably you, if CRNAs did a 3yr fellowship in pain management, had their Phd in neuroscience, and/or a CRNA had years of chronic pain management research under their belts. What truly matters to the AMA/ASA is that CRNAs aren't physicians. Everything else is just party-line biased opinion. The ASA/AMA have no research backing up their claims and neither does the AANA (I checked).

My guess is that their are so few CRNAs doing chronic pain management on their own that no valid research can be done to have an adequate power analysis/statistical significance between the two with such a small sample size.

deepz · Mar 2, 2008

A hands-on cadaver course open to all physicians and CRNAs of all skill levels that want to learn pain management from assessments to image guided interventional techniques. Three day course will include both didactic and hands-on including a physical assessment lab and extensive hands-on cadaver training using fluorscopy.

MAY 2-4

Doubletree Chicago-Arlington Heights

19 CEUS pending AANA approval

http://www.napeseminars.com/pages/seminars.html

n_g · Mar 2, 2008

I have personally known FPs to do C-sections, tonsillectomies, interventional pain management and a variety of other procedures they were never board certified for or had any kind of formal training in other than someone showing them once or twice.

To do obstetrics such as c-sections, FP's need to complete a year long fellowship after residency. You don't learn how to do a c-section after watching one or two of them.

A medical license grants the holder the most latitude of any degree. The degree states in fact that the holder is licensed to do medicine and surgery. Does your degree say that? If you wanted to do more, then maybe you should have gone that route. If we use your argument, pretty soon we'll have CRNA's doing solo surgery. The CRNA degree does not grant you carte blanche to enter any field you like.

allnurses Guide · Mar 3, 2008

To do obstetrics such as c-sections, FP's need to complete a year long fellowship after residency. You don't learn how to do a c-section after watching one or two of them.
A medical license grants the holder the most latitude of any degree. The degree states in fact that the holder is licensed to do medicine and surgery. Does your degree say that? If you wanted to do more, then maybe you should have gone that route. If we use your argument, pretty soon we'll have CRNA's doing solo surgery. The CRNA degree does not grant you carte blanche to enter any field you like.

Apparently, you don't know that many older FPs, but then again it is not worth debating someone that won't be honest enough to declare their educational training/or lack there of up front.

I guess we have come full circle in this debate with "you're not a physician so you can't do that" arguement again. Your statements are neither unique or show any kind independent thought. Statements like yours can be pulled almost verbatim from the CRNA hate rhetoric from the student doctors network. I think it would be easier to just start posting links to all those anti-CRNA rhetoric from the SDN instead of retyping all of it over and over again.

n_g · Mar 3, 2008

Paindoc your rhetoric about weekend courses/"weekend warriors" being the only training that CRNAs practicing chronic pain management is starting to sound like a broken record. You have absolutely no proof that this is their only training! It is just the typical rhetoric of AMA/ASA to defend their case against CRNAs doing chronic pain management... absolutely no proof but it sounds compelling for the uninitiated into the political doings of the AMA/ASA. The same goes for educational differences between physicians and CRNAs doing chronic pain management no one has any proof that it makes any difference in patient outcomes, but it sounds good for your case to keep pointing out the educational differences. The same arguement is used against CRNAs and independent practice, but the big difference there is that there is plenty of research showing CRNAs perform just as well as MDAs in independent anesthesia practice. It wouldn't matter to the AMA/ASA, or probably you, if CRNAs did a 3yr fellowship in pain management, had their Phd in neuroscience, and/or a CRNA had years of chronic pain management research under their belts. What truly matters to the AMA/ASA is that CRNAs aren't physicians. Everything else is just party-line biased opinion. The ASA/AMA have no research backing up their claims and neither does the AANA (I checked).
My guess is that their are so few CRNAs doing chronic pain management on their own that no valid research can be done to have an adequate power analysis/statistical significance between the two with such a small sample size.

I'm sure the LA AANA will appeal the decision specifically banning CRNA's from doing pain.

If you have great arguments and evidence, you're more than welcome to participate and convince the courts that CRNA's should be allowed to do pain. This is your chance to prove to the world that you're right. Otherwise, this sounds like crying over spilled milk.

allnurses Guide · Mar 3, 2008

I'm sure the LA AANA will appeal the decision specifically banning CRNA's from doing pain.
If you have great arguments and evidence, you're more than welcome to participate and convince the courts that CRNA's should be allowed to do pain. This is your chance to prove to the world that you're right. Otherwise, this sounds like crying over spilled milk.

Actually, unlike some of the other posters on here...that won't share their educational background...I freely admit that there is no research to support or denounce chronic pain management by CRNAs. I even went to the trouble to check pub med and email the AANA myself to look for the research.

Then again n_g if your such an expert in all things to do with advanced practice nursing/CRNAs why don't you tell us where your expertise lies other than reading the SDN forum.

Point of Clarification: LA state law has virtually no impact on what my practice will be...I am AD military, and I'm regulated by federal law/military-AF scope of practices. I personally am only interested in autonomy for CRNAs. I can't imagine spending my career doing chronic pain management it seems totally opposite to why you would get into anesthesia in the first place, whether you are an MDA or a CRNA.

paindoc · Mar 3, 2008

Au contrare...I do have such proof. Having queried every CRNA school in the country and having responses from their program directors is proof enough. The only formal training available is well, unavailable. The weekend seminars being used to train CRNAs in an entire specialty (NOT anesthesiology, but the bona fide specialty of pain medicine) are insufficient. The erroneous concept you have that the AMA or ASA must prove CRNAs should not do pain is the inverse of reality....that CRNAs should place patient safety above all other considerations, and create their own fellowship programs or residency in pain. Without such, CRNA training is woefully inadequate for pain management. The ridiculous argument that since there is no data available for CRNAs performing pain management then it must be inherently safe is a far more arrogant and presumptuous attitude than even your sworn enemy the ASA holds towards CRNAs. If you don't have data, don't have research, and don't have adequate training to perform pain management, then CRNAs, FPs, or any other specialist without adequate preparation is unnecessarily risking the lives and health of the patients they are treating. Shame on the AANA for encouraging the uneducated and untrained, some armed with a 2 year RN diploma plus one year certificate that qualifies them as a CRNA, to engage in such risky practices.

foraneman · Mar 3, 2008

A medical license grants the holder the most latitude of any degree. The degree states in fact that the holder is licensed to do medicine and surgery. Does your degree say that?

Apparently your argument is that any licensed physician is qualified to practice any branch of medicine or surgery. I'll be sure to let my next door neighbor psychiatrist know. If that is not your argument then why make this statement? WHAT IS YOUR POINT?

If you wanted to do more, then maybe you should have gone that route. If we use your argument, pretty soon we'll have CRNA's doing solo surgery. The CRNA degree does not grant you carte blanche to enter any field you like.

This is absurd. Pain Management historicaly has been an anesthesia specialty. Ridiculous arguments regarding CRNAs wanting to perform "solo surgery", cardiac catheterizations, brain transplants or other such nonsensical rhetoric are the desperate ramblings of individuals void of arguments based in science or evidence. They are also childish

. :yeah:

foraneman · Mar 3, 2008

Au contrare...I do have such proof. Having queried every CRNA school in the country and having responses from their program directors is proof enough. The only formal training available is well, unavailable.

falsus in unum, falsus in omnibus

I hate to call you a liar.... Had you contacted every program director, and had you recieved replies from each, two things would be apparent.

1. You have accomplished something every researcher before you has dreamed about....a 100% response.

2. Many CRNA programs include pain management in their curriculum, including clinical experience in a pain clinic administering blocks. My knowledge of this is first hand, up close, in person, with my own eyes.