Should Anesthesia Be an only MD Profession

Pete495 · Mar 1, 2004

good LINK DeepZ. I'd been looking for something that described the nursing side of anesthesia because all i've heard lately from peers is that anesthesia is not nursing, it's medicine. It's difficult to describe the support that a registered nurse anethetist provides during the course of anesthesia. Granted, a lot of it is physiological, but it also has a lot to do with reading your patient, their vital signs, and even their appearance and reaction to anesthesia and your procedure. I also think it is ironic that most CRNA's through a discussion on allnurses said they would never go back to bedside nursing. I cannot blame them at all. I just found it kind of funny.

Also, I believe I said that there was a PERCEPTION that CRNA's are doing more because of the shortage. I think I also pointed out that I would probably get ragged on for that comment. Not that it matters. I posed it as a question anyway. I wanted to know if anesthetists were doing more, less, or about the same when it comes to pushing drugs and doing procedures. So far the general response I've gotten is that CRNA's are doing what they want and are able to do. Should a CRNA have to ask the MDA to put in a central line ? Ha! See, the line between physician supervision and independent practice is still murky even in the face of independent practice.

loisane · Mar 2, 2004

Curative vs. supportive. Yep, sometimes those nursing theory classes do have some substantive meaning! (hehe) Seriously, I believe these questions are important. We're all clinicians, we want to cut to the chase and talk about how to do things, based on outcomes, something applicable, etc. So, sometimes we are impatient with less concrete issues. But there is also a place for philosophy, theory and more abstract discussions, such as these.

In regard to what clinical experiences SRNAs need to graduate, there are new standards effective this year. There are increases in total number of cases, and in most categories. The AANA website has the new standards, under the accreditation section. It is members only, so you need your membership and PIN to get access.

loisane crna

loisane · Mar 2, 2004

David said

"Many have the perception that in the past clinical procedures were only taught to MDA's rather than CRNA's, and now that there is a shortage of anesthesia care providers, CRNA's are doing more today than they ever have in the past. Please remember this is a general perception, not MY perception. (I don't want ragged on for this).

The scope of practice for CRNA's has definitely expanded, as one should expect."

I hope I don't sound like I am ragging on you. Instead, I am making the point that I believe people with this perception are wrong. Those with this perception are probably the same people who think CRNAs are RNs who have had a little extra on the job training, and are just there to help the MDA. In other words, they have bought the ASA rhetoric that anesthesia is better when MDs are involved, and the ideal situation is to have 100% MD delivered anesthesia.

This is not how anesthesia has been delivered historically. CRNAs have ALWAYS been involved in full scope of practice anesthesia. It is not something new, no matter what you have heard. I work with CRNAs who practiced anesthesia when there were NO MDAs around. Of course they did it all, there wasn't anybody else! MDAs might have existed elsewhere at that time, but not in this town.

I believe that the idea that "CRNA's are doing more today than they ever have in the past" is a myth. Nothing personal, just MHO.

loisane crna

smiling_ru · Mar 2, 2004

I was fortunate in that the school I attended allowed us to do all procedures and a lot of them.

When I started working I was told that there were certain procedures which were only performed by the docs. Central lines, some blocks. I approached each MDA and stated that these were skills I had learned in school and that I did not want to lose. They agreed that I should not lose those skills, and I place my own lines/blocks. But, I think I am the only CRNA where I work who is placing central lines. The only reason I can think of for this, is that the others have not made a point of doing them.

The supervision model is in use, so the MDA's do come in on induction. But, they do not push my drugs, they hold the mask or hand me the OETT, no infringement on practice, but an extra set of hands if needed.

I know that there are plenty of places where it is a power issue and nothing will change the status quo. But, you never know until you ask.

Oldsalt · Mar 3, 2004

In speaking with a fellow anesthetist today, he indicated that the aggressiveness of many MDA groups (as well as the ASA dictums) have been increased .......seeking to ensuring limiting CRNA practice and to further provide the settings in which CRNAs are supervised.

The turning point? Possibly the lawsuit in Minnesota (Minnesota Association of Nurse Anesthetists vs Unity Hospital, et al).

In a time of increased public concern about healthcare costs - the anesthesiologist have to be business savvy and to ensure that they can maintain the higher compensation for those every shrinking healthcare dollars.

Greater control / Greater reimbursement = limiting CRNAs scope of practice

Money always seems sacrosanct when it comes down to it....

Roland · Mar 3, 2004

If MDA's are being more aggressive in limiting the scope of CRNA's practice then it would behoove the AANA and CRNA's everywhere to consider an effective response. Do you have any suggestions as to techniques that could be employed to limit this effort? Below is a link to a paper which covers the issue at some length, but may be worth the time to read. The conclusion of the author seems to be that CRNA's need to undertake a proactive rather than reactive posture when it comes to establishing their scope of practice both with regard to public relations and litigation.

http://216.239.39.104/search?q=cache:Ju9RzA_2BoMJ:firms.findlaw.com/lkarlet/memo4.pdf+Minnesota+association+of+Nurse+anesthetists+versus+Unity+Hospital&hl=en&ie=UTF-8

Oldsalt · Mar 3, 2004

Thank you for your post and link....

I find that many points are very detailed in description - but one seemed to catch my attention where Judge Bennet had remarked from Randall v. Buena Vista City. Hosp:

"...there is no dispute that "tied" products were created by the Hospital's exclusive contract for anesthesia services with the Clinic Foundation, because, under that agreement, the Clinic Foundation had the exclusive right to provide anesthesia services at the Hospital. What remains to be seen, inter alia, is whether there are genuine issues of material fact concerning exploitation of the Hospital's control over its services to force patients to purchase the "tied" anesthesia services. Cf. Jefferson Parish Hosp., 466 U.S. at 12. On that question, the court finds the barest suggestion from the record that consumers actually differentiated between the anesthesia services provided by the Clinic Foundation and other providers, and thus, by the barest of margins, there is a genuine issue of material fact as to whether the exclusive provider contract professions have been well established by case law, academics, legislation, and sheer common sense."

Hence, are patients (consumers) really able to differentiate between the anesthesia services provided to them?

I doubt it very much.

Nor are they able to be objective consumers - since the belief that MDA's can provide the highest quality of anesthesia care, has been ever pervasive in the public's mind.

But this also brings up the other real issue.....That patients, because of the ASA work, have been FORCED to pay for the highest Tiered Service when both MDA's and CRNA's are in the same hospital setting.

How have the MDA's gotten around this?

To ensure that CRNA's CANNOT COMPETE and offer equal services (by restricting practice, writing supervision bylaws, etc....)

.....Hence the patient will NOT have a choice in service costs......

Where does the answer lie? On this, I must take some time to think....

Regards.....