The AANA, the ASA, and the SDN

Published

It seems like about once every six or eight months, someone goes over to the Student Doctor Network and finds some particularly inflammatory remarks about nurse anesthetists. Then, we get a thread here with a title like "Look at What Those Nasty Guys Are Saying about Us!"

Okay, everybody take a deep breath, step back and relax. First, realize that Student Doctor Network is just that; a forum for STUDENT doctors. Just as we did when we were student nurses and student CRNA's, they are bound to run into things during their education that will surprise them, and perhaps frustrate them. They need a place to go vent about these things. Add to that the fact that new residents in anesthesia have only what they have been taught to go by. If they're taught that nurse anesthetists are mean, evil and out to take the practice of anesthesia away from physicians, then they're going to start out with a bias against CRNA's. That bias will show up in their posts. But in continuing their residency, most physicians find that nurse anesthetists are an important part of the anesthesia care team.

Frankly, I'm sick to death of the arguments between CRNA's and anesthesiologists, particularly since these arguments are promulgated by our professional organizations. Down here in the trenches, nurse anesthetists and anesthesiologists get along quite well. I have found that most anesthesiologists I have worked with prefer to work in a collaborative environment, particularly when presented with complex or difficult cases. Having the initials CRNA or MD behind your name does not guarantee that you know everything. Most CRNA's and MD's are more than happy to hear other viewpoints. Generally, I have found the more experience you have, the more willing you are to listen to other viewpoints.

As to some of the most inflammatory comments made, don't worry about it. Generally, these people will do more harm than good for their "cause." If the American Society of Anesthesiologists were to completely get their way, and place all nurse anesthetists under the medical direction of anesthesiologists, there are a number of hospitals that would have to close down. Surgeons at these hospitals would find themselves without a place to practice. As a result, the ASA would quickly find themselves at odds with the American Hospital Association, and the American College of Surgeons. Smaller hospitals, with just a few OR's generally cannot afford to hire an anesthesiologist to supervise the two or three nurse anesthetists that they have on staff. Were there suddenly to be a nationwide requirement as desired by the ASA, these hospitals would have to shut down their operating rooms. I know this for a fact, because I have worked at hospital like that. And should that hospital have to close it's OR's, the hospital itself would likely have to close within about six months.

The short version is don't worry about what's posted at the ISDN. Just as we need a place to vent, so do physicians. If an anesthesiologist goes on the board and refers to nurse anesthetists in a derogatory manner, let it go. Frankly, we need a lot less infighting and a lot more cooperation.

Kevin McHugh

Specializes in PICU, Gen ICU.

I hope your leadership becomes infectious! Cool, clear thinking should be addictive.

Have a great day!

First, realize that Student Doctor Network is just that; a forum for STUDENT doctors.

I think I can see the overall point Kevin is making here, by trying to put SDN in perspective. I can even agree with him, to a point. Kevin, I respect you as a colleague, and the time and contributions you have made here are admirable. But some of your post hit a very strong nerve with me, and I must respectfully challenge some of your conclusions.

Add to that the fact that new residents in anesthesia have only what they have been taught to go by. If they're taught that nurse anesthetists are mean, evil and out to take the practice of anesthesia away from physicians, then they're going to start out with a bias against CRNA's.

I believe this is an accurate description. But doesn't it bother you that this occurs? Why should medical education include such harmful rhetoric? I have worked with many new residents, and it is evident to me that there is organized, structured misinformation shoveled to them about the scope of nurse anesthesia practice. This concerns me greatly. I do not believe that a complacent, "let's just all get along" response is the best for me personally or for my profession.

Don't get me wrong, I can work side by side with the worst of them. I do so with grace, dignity and the utmost respect for them. But I also call them on things when they are wrong, and refuse to take a subserviant, handmaiden demeanor, even if that is in fact how I have to perform in that particular work situtation. They can make you act like a slave, but they cannot control your attitude and spirit.

Frankly, I'm sick to death of the arguments between CRNA's and anesthesiologists, particularly since these arguments are promulgated by our professional organizations.

I must register my strongest disagreement with this statement. This is a very dangerous attitude, IMHO. If the rank and file nurse anesthetists keep their head in the sand about the professional relationships of these two disciplines, our profession is in great danger. Please, please continue to read, talk to colleagues, and develop you personal opinion on this. Remember to look at things objectively, and critically. I hope you do not retain this point of view as your thinking evolves.

Down here in the trenches, nurse anesthetists and anesthesiologists get along quite well. I have found that most anesthesiologists I have worked with prefer to work in a collaborative environment, particularly when presented with complex or difficult cases.

Is your work situation really as collaborative as you describe? How are your cases being billed? If your ACT bills for medical direction, as many do, this is not collaboration. The 7 TEFRA requirements do not allow for full scope of nurse anesthesia practice, by their very nature. And if your ACT bills for medical direction, and does not meet them, they are committing fraud. (This is a very common occurence).

And even if your particular anesthesiologists really are supportive of full collaboration, does it not bother you that thier professional organization does not promote that same agenda? I agree with you that SDN is of limited usefullness (although I do think it is valuable to gain insight into their thinking). But for a real eye opener, people should read the ASA website, as I am sure you have. The ASA holds many positions that are incongruent with full collaborative practice. They say TEFRA requirements are standards of care, meaning to not fulfill them is not good practice. They say that only anesthesiologists should perform regionals. They say that all anesthesia is the practice of medicine, and nurse anesthesia is not autonomous practice, but is instead delegated medicine. I am not drawing may own inflamatory conclusions. These are facts, check their website.

I have never understood this inconsistency: Many CRNAs say their work relationships with anesthesiologists are just great, and they don't understand what all the fuss is about. Where are all these great, CRNA friendly anesthesiologists when it comes time to set ASA policy? If there are really so many of them, why is there organization so different?

If the American Society of Anesthesiologists were to completely get their way, and place all nurse anesthetists under the medical direction of anesthesiologists, there are a number of hospitals that would have to close down. Surgeons at these hospitals would find themselves without a place to practice. As a result, the ASA would quickly find themselves at odds with the American Hospital Association, and the American College of Surgeons.

I believe this line of reasoning seriously underestimates the potential impact of such a scenario. Frankly, I am afraid it is just used as a rationalization for not getting involved, and doing nothing. Maybe not to you, Kevin. But I think far too many CRNAs fall into this trap.

Frankly, we need a lot less infighting and a lot more cooperation.

I can agree to less fighting. But I don't know about cooperation, at least not yet. We have a lot of work to do before it gets to that point. This is business, and subject to the ups and downs and negotiating associated with business. Sometimes it gets messy. We can't let ourselves get rolled over just because we want to avoid conflict.

On a final note, I think there is one more issue here to address. That is gender. Kevin, you are male. You simply cannot assume that what is true for you is going to be equally applicable to our female members. Many have witnessed a huge disparity in the relationships of anesthesiologists with male vs. female CRNAs. As unfortunate as this is, it is a fact of life that we all have to live with.

Anesthesia is a volatile environment. It isn't going to get better by compromising to avoid conflict. I am sorry you feel that way. I am sorry that many CRNAs feel that way. But there are many who recognize the need for a strong professional presence. I support them.

loisane crna

Loisane, I can relate to your post and agree with you on your assessment of Kevin's post. I hope both of you are members of [email protected], where there are usually great discussions on CRNA/MDA relationships. On that forum there are a lot of great CRNAs who are constantly working to maintain our practice rights and provide an incredible amount of insight into the issues.

Even though I haven't practiced with an anethesiologist for over 20 years, I have had plenty of experience before I went out on my own. I think there is a basic cultural difference between doctors and nurses, which is made more obvious when both groups can do the same thing (administer anesthesia) with the same quality. Anesthesiologists are interested in getting along with nurse anesthetists as long as there is an economic or power motivation. To think otherwise is incredibly niave. It is so much of the nursing culture to want to have everyone happy, even if you have to sacrifice for it.

As far as I am concerned, neither CRNAs or anesthesiologists are going to go away as long as their are patients needing pain relief for surgery and procedures. My big concern is the need by the ASA to control or otherwise restrict CRNA practice, as is evidenced by their move for restrictive legislation against CRNA independent practice.

I think those on this forum who are students or perspective students should give a lot of thought to this topic. When I ask RNs why they want to be a CRNA, the PRIMARY reason is the opportunity for independent practice. Believe me, it is not an independent practice when an anesthesiologist does the pre-anesthesia evaluation, selects the anesthesia technique, pushes the induction agent and comes back for the emergence.

I am not promoting private practice for all CRNAs, but the RIGHT to practice alone should always be protected.

Yoga CRNA

But doesn't it bother you that this occurs? Why should medical education include such harmful rhetoric? I have worked with many new residents, and it is evident to me that there is organized, structured misinformation shoveled to them about the scope of nurse anesthesia practice.

As I posted in another thread recently, the lack of objectivity here is sometimes striking.

My group goes to job fairs and recruiting trips at a number of CRNA schools in the southeast. I can paraphrase your comments this way --- Why should nurse anesthesia education include such harmful rhetoric? I have recruited many student CRNA's, and it is evident to me that there is organized, structured misinformation shoveled to them about the scope of AA practice.

All of us want to promote our own professions - CRNA, MD, and AA alike. It really is a shame that we can't do that without bashing the other. I think Kevin's post is excellent, and reflects the way things are in the majority of areas and practices in the country.

There will always be fundamental differences of opinion about CRNA vs MD practice. Those won't change. Thoughtbridge certainly won't do it. In many cases, it's just going to end up being an agree to disagree kind of thing.

Why should nurse anesthesia education include such harmful rhetoric? I have recruited many student CRNA's, and it is evident to me that there is organized, structured misinformation shoveled to them about the scope of AA practice........... I think Kevin's post is excellent, and reflects the way things are in the majority of areas and practices in the country.

I don't believe the pros and cons of AA practice are germane to this particular discussion.

Kevin's post reflects his opinion. Other have different opinions. Inferences about the majority of this country should be based on information far more diverse and comprehensive than the limitations of this particular forum foster or allow.

loisane crna

Specializes in Oncology/Haemetology/HIV.
I don't believe the pros and cons of AA practice are germane to this particular discussion.

And why not?????????

JWK I disagree with you in my CRNA school we rarely touched on AAs I here much more rhetoric on here between AAs and CRNAs than I have during my program.

As I posted in another thread recently, the lack of objectivity here is sometimes striking.

My group goes to job fairs and recruiting trips at a number of CRNA schools in the southeast. I can paraphrase your comments this way --- Why should nurse anesthesia education include such harmful rhetoric? I have recruited many student CRNA's, and it is evident to me that there is organized, structured misinformation shoveled to them about the scope of AA practice.

All of us want to promote our own professions - CRNA, MD, and AA alike. It really is a shame that we can't do that without bashing the other. I think Kevin's post is excellent, and reflects the way things are in the majority of areas and practices in the country.

There will always be fundamental differences of opinion about CRNA vs MD practice. Those won't change. Thoughtbridge certainly won't do it. In many cases, it's just going to end up being an agree to disagree kind of thing.

I don't believe the pros and cons of AA practice are germane to this particular discussion.

Kevin's post reflects his opinion. Other have different opinions. Inferences about the majority of this country should be based on information far more diverse and comprehensive than the limitations of this particular forum foster or allow.

loisane crna

I'm not trying to point out the pros and cons of either type of practice. I'm just pointing out the inconsistencies and lack of objectivity. It's not OK for the ASA to hold the views they do, yet many CRNA's hold very similar views towards AA's.

Specializes in Psychiatric.

I say nay- this is not true. They are fighting the CRNA’s, and they are going to whomever they need to to present their argument in order to do so. I know because my older sister is a Nurse Anesthetist- and this has long been a worrisome topic for her and to my family. The Doctor’s argument is that the CRNA’s are causing them to loose money and it is not fair to them that they had to go through eight years of college and then do a residency before they could make these monies. Where as we Nurses only had to do a fraction of the time in school and still come out making a decent living. I feel that this is just greed on their part. Do they actually think that we will take every patient away from them- and that they won’t get their fare share? That is ridiculous! There are to many other pertinent issues that we all need to worry about. How about safety for the Nurses and the Doctor’s? Or what about the Nurses being over worked and the Hospitals understaffed? I just thought we were in the business to save lives-Because we care.

A. Ahee,SN

This horse has been beaten to death. This debate is always going to go on it has for over 70 years now. I take comfort in how far CRNAs have come and gained through the tireless efforts of those before me. What I see is CRNAs fighting uphill battles and continually coming out on top. It's the only nursing profession that really has a common goal and sticks together and it will always be that way. This is why it is so important to support the AANA.

:balloons:

Hi everyone,

I am looking for standards for syringe labelling in critical care areas.

I know that we MUST check drug ampule and correctly label the syringe,but I like to know which colours You use (International?Regional ?) and what do You write on the syringe label.

Thank You

Loisane, I can relate to your post and agree with you on your assessment of Kevin's post. I hope both of you are members of [email protected], where there are usually great discussions on CRNA/MDA relationships. On that forum there are a lot of great CRNAs who are constantly working to maintain our practice rights and provide an incredible amount of insight into the issues.

Even though I haven't practiced with an anethesiologist for over 20 years, I have had plenty of experience before I went out on my own. I think there is a basic cultural difference between doctors and nurses, which is made more obvious when both groups can do the same thing (administer anesthesia) with the same quality. Anesthesiologists are interested in getting along with nurse anesthetists as long as there is an economic or power motivation. To think otherwise is incredibly niave. It is so much of the nursing culture to want to have everyone happy, even if you have to sacrifice for it.

As far as I am concerned, neither CRNAs or anesthesiologists are going to go away as long as their are patients needing pain relief for surgery and procedures. My big concern is the need by the ASA to control or otherwise restrict CRNA practice, as is evidenced by their move for restrictive legislation against CRNA independent practice.

I think those on this forum who are students or perspective students should give a lot of thought to this topic. When I ask RNs why they want to be a CRNA, the PRIMARY reason is the opportunity for independent practice. Believe me, it is not an independent practice when an anesthesiologist does the pre-anesthesia evaluation, selects the anesthesia technique, pushes the induction agent and comes back for the emergence.

I am not promoting private practice for all CRNAs, but the RIGHT to practice alone should always be protected.

Yoga CRNA

I have to respond to this comment... If nurses wanted to practice independently they should become physicians.. seriously. This is just a patient safety issue. The safest thing for the patient is for a physician to direct there medical care, period. If you wanna be captain go to captain school. I dont have any objection for autonomy just as long as you went to medical school period.. I dont care how long a crna has been a crna, there is no equivalent to years of the standards that physicians have to adhere to in college, medical school, residency and when we sit for the American Board of Anesthesiology exam. period. people on this board can rant and rave until they are blue in the face but that will not make them physicians who practice independently. **** go to medical school. Its not that bad..

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