Scope of Practice

allnurses Guide · 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.

So, 10 pages of debate and everyone is saying the same thing over and over.....you have said almost this exact same thing before....I don't agree with you, no matter how many times you say it and neither do most of the nurses on here. You constantly trying to undermine the education of CRNAs doesn't work either. It has been years since CRNAs have graduated with anything less than a Master's degree. There are still practicing diploma CRNAs, but they are all nearing retirement (not that there is anything wrong with diploma grads..it is the practice/residency that defines the nurse or the physician not the classroom). Also, there are two CRNA programs in the country that have already moved to the DNP.

If you have polled all CRNA programs in the country where is your published work, w/o that we have only your word. I directly have contraindicated your statement that CRNA schools don't teach chronic pain management. We have had several lectures at my school on chronic pain, chronic pain management, and more than I wanted to ever hear about pharmacology & chronic pain management.

If the ASA/AMA are so interested in patient safety, why don't they clean up their own house first and make all these non-fellowship/non-residency trained chronic pain physicians stop practicing chronic pain management.

I would hardly say that ASA is my "sworn enemy", but they are not the friend of any CRNA/SRNA. ASA is a political organization first and foremost meant to protect MDA monopolies.

paindoc · Mar 3, 2008

Actually I said INTERVENTIONAL pain procedures are not being taught in CRNA school. If you had fluoroscopically guided injection training in CRNA school, pray tell us where so I can contact the school for verification. As for CRNA= 3 years to 8 years of training, that is a fact. The AANA gives the same level of certification to a 2 year certificate RN plus one year CRNA school without masters degrees (which by the way according to the AANA website was not fully implemented until less than 10 years ago so it is difficult to see how you think all these nurses that obtained non-MS degrees are near retirement) as it does to nurses well trained in OR and OB anesthesia with DNP degrees. No other professional certification organization has such a wide lattitude in the meaning of "certified". Nonetheless, even DNP nurses are not trained in the management of chronic pain. If you think a couple of hours of training in non injection chronic pain management qualifies you to treat comprehensive pain management, then heaven help those patients that would naively enter your realm.

n_g · Mar 3, 2008

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?

Would an internist believe that he could suddenly become a brain surgeon with a few weekend courses?

Even though their medical licenses allows them to practice medicine and surgery, physicians are not arrogant or stupid enough to believe that they can practice safely outside of their training. If an internist wants to do surgery, what does he do? He goes back and does a residency in surgery.

A CRNA degree certifies the holder that he/she is qualified to deliver anesthesia. Pain is not within the scope of your training. Nobody buys your argument that it does and by their rulings neither do the courts. Weekend courses with cadavers does not mean you're qualified to suddenly perform invasive pain procedures on live patients. Like I said, if you got great evidence or arguments, step up to the plate and convince the courts why you're right and they're wrong.

If you want to do pain, then nursing programs need to include that as part of their training. However, there are some obstacles to that. 1) don't hold your breath that pain docs will happily train CRNA's to do pain. 2) performing invasive procedures like cutting someone open to insert something like a baclofen pump is not within the scope of nursing. Even if CRNA's do pain, it will never be as comprehensive as a pain doc because they can't do really invasive stuff. You basically can just inject.

Biotechnology · Mar 3, 2008

I just thought that I should give my on the issue. Now I understand where CRNA's feel like they should have a say in pain management, because I believe there is a place in pain management that they could be part of...especially when you are giving pain meds during procedures. That makes total sense!!! I gotcha on that.....What I DON'T understand is where CRNA's feel that they should 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.....ya'll get my drift all after a weekend course. These are the things that separate pain physicians from anesthetist....the physicians do an extra 2-3 years to learn this stuff. Now I understand what nurseKaren is trying to say, that things are evolving...but they are evolving with the proper education to back it up! Now maybe in the future, it will change but for now, at least the part of pain management that I am refering to should remain in the physicians court. (Now I should also note that I am referring to what pain management does in my state and what they do in the OR that I work in....)

I just felt the need to re=post what was already posted by me because ya'll seem to be going around and around what was already mentioned;)

stanman1968 · Mar 3, 2008

Dude just "injecting" is what a large argument is about. What do you think most treatments are? Spinal cord stimulator, pain pumps? Yeah they are there but that is not the bread and butter of a pain practice it is just those basic "injections"

According to you they are pretty basic so obviously a highly trained and skilled practitioner such as myself is in a much better position to judge my competency and my peer groups competency over an untrained uncertainly trained individual as yourself, hey all you can do is type.

jwk · Mar 3, 2008

ASA is a political organization first and foremost meant to protect MDA monopolies.

Remember - you can freely subsitute AANA for ASA in the sentence above and still be 100% accurate.

stanman1968 · Mar 4, 2008

yeah well JWK if the AA were not such an open play to create a more dependent midlevel to replace the CRNA it would not be an issue. Note more Dependent by law not by ability IMO. I think the AANA should find a way grandfather in AA's so that they to may have independent practice.

allnurses Guide · Mar 4, 2008

Remember - you can freely subsitute AANA for ASA in the sentence above and still be 100% accurate.

I don't disagree with you that the AANA is out to protect CRNA professional interests at all, but CRNAs are far from having monopoly on anesthesia services.

AAs are another issue all together in the grand scheme of things. You should start another thread if you want to discuss AAs/ASA and AANA. This thread is getting too long as is.

allnurses Guide · Mar 4, 2008

Actually I said INTERVENTIONAL pain procedures are not being taught in CRNA school. If you had fluoroscopically guided injection training in CRNA school, pray tell us where so I can contact the school for verification. As for CRNA= 3 years to 8 years of training, that is a fact. The AANA gives the same level of certification to a 2 year certificate RN plus one year CRNA school without masters degrees (which by the way according to the AANA website was not fully implemented until less than 10 years ago so it is difficult to see how you think all these nurses that obtained non-MS degrees are near retirement) as it does to nurses well trained in OR and OB anesthesia with DNP degrees. No other professional certification organization has such a wide lattitude in the meaning of "certified". Nonetheless, even DNP nurses are not trained in the management of chronic pain. If you think a couple of hours of training in non injection chronic pain management qualifies you to treat comprehensive pain management, then heaven help those patients that would naively enter your realm.

I went and looked at your old posts and still didn't see the one where it said interventional pain management, but I will take your word for it. This thread is getting long. Anyways in being fair, in general at my school we are not taught fluroscopically guided injection training as far as I know...we have discussed it a little bit, but I am pretty sure it plays no major part of our training.

Nurse anesthesia students are not like med students the average age of most students starting NA is generally around their mid-30's, no matter what the minimum requirements are, most NA students don't get into school with just 1yr critical care expeirence. So giving the fact that it has been 10 yrs since the requirement for a Masters took place and most schools switched over years before the requirement for Masters became effective (just like some NA schools are switching over to DNP now 15+yrs ahead of time) that makes most diploma CRNA in their 50's+ which is consistent with the ones that I have met. I am sure that there is probably some diploma grads out there that our in their 40's but they are far from the majority.

Again you have absolutely no proof that the only training CRNAs doing chronic have is a weekend course, but I guess as long as it sounds good to you you will continue to say it...over and over and over again.

Since, I don't ever plan on practicing any kind of chronic pain management I think you are pretty safe, but I would much rather be treated by a CRNA doing interventional pain management that learned their skills through OJT and "weekend courses" than egotisical physician that thinks their diploma has made them a omnipotent deity with no limits on their scope of practice.

n_g · Mar 4, 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

Exhibit A: typical weekend course

I'm waiting for wtbcrna to post info about accredited and recognized programs that comprehehsively trains CRNA's to do pain that would make them equivalent to pain docs. He seems convinced that such programs exist so I'm waiting for the evidence.

I'm waiting...

deepz · Mar 4, 2008

....I'm waiting...

You apparently can't admit you are wrong, ng, despite being shown in plain English that the LA SUPREME Ct did NOT as you claim find pain to be strictly a physician function (District Ct, one judge, remember?), so why should anyone here care if you wait and wait till the cows come home.

And your qualifications again?

allnurses Guide · Mar 4, 2008

Exhibit A: typical weekend course
I'm waiting for wtbcrna to post info about accredited and recognized programs that comprehehsively trains CRNA's to do pain that would make them equivalent to pain docs. He seems convinced that such programs exist so I'm waiting for the evidence.
I'm waiting...

Actually, I like to stick with truth and state when something is my opinion. Now if you through being an SDN spokesperson, why don't you quit posting or tell us your background! That is the only pertinent thing left undiscussed on this thread.

So, if it is a weekend course and a physician goes to it...That has to mean that it is the physician's only interventional pain training by yours and Paindoc's logic.

I'm waiting along with everyone else..... for your credentials.