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

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..

:chuckle and y'all think I'm bad...

I thought this thread had died....

My grandmum always told me, "Girl, I been cookin' since before the pig became a hog. Don't be so 'grabalicious'. I made enough pie for everyone."

Specializes in Anesthesia.
... If nurses wanted to practice independently they should become physicians.. seriously. .....

Antedeluvian.

deepz

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..

Can you show us some studies that show evidence that anesthesia care is safer with an MD than a CRNA? If you can't, what you've said is just opinion.

(sorry guys, I just had to say it.)

I have to respond to this comment...

And I yours....I see that you have trolled yourself right over here and obviously go to bat for the MD team. That's fine. What you need to realize is that you either don't know not a whole lot about anesthesia or either you think you know a great deal more than the miniscule amount that you DO know. Either way, you don't have the whole picture of anesthesia so don't pretend that you do. I'm guessing you are a MS that wants to be an anesthesiologist, correct me if I am wrong in my assumption sometime.

If you are at a medical teaching institution and work with CRNAs, then you have a slighted view of how the real world operates. CRNAs at these places work there because they like the environment of teaching and they catch alot of flak because these individuals are often left with the crappiest cases around, but magically become brilliant when the residents or students want or need to leave. In the shadows beyond the realm of medical teaching institutions (sarcasm intended) CRNAs are much more independent, infact perform major vascular, neuro, lung, and gasp....even cardiac cases without input from the MDA. CRNAs can practice as a member of ATC which may just infact be team care on paper, or some practice independently. Yes, I can preach this, but you will have to realize that CRNAs are not the lemmings that you think they are one day, and I wish I was somewhere around when you realize this and I'm sure you will think the sky is falling. Just because you don't think it doesn't happen doesn't make it true.

The safest thing for the patient is for a physician to direct there medical care, 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 BLAH, BLAH, BLAH.....

I personally added the ending to that because I was tired to retyping your rhetoric. Look up a study performed by Michael Pine in comparing outcomes based on anesthetic provider. The findings may suprise you. Then look up the ASA's response and then Mr. Pine's response to the ASA response. Oh and take all this into consideration after learning that Mr. Pine is actually DR Pine, a BC cards who happens to be a statistics guru. So until you come with substantial evidence, don't bother sharing your anti-CNRA opinions here, because that is all it boils down to - an opinion. You have yours and I have mine.

Speaking of that, some posters here, myself included, go the the SDN on a frequent basis. A kind of unspoken rule that has evolved through postings is that a member of the opposite site is welcome to talk and interact, just don't start political propaganda. It would be nice if you would abide by this also.

If all you came here for was a flaming troll, then you have succeeded. But please google the Michael Pine study and examine it for yourself.

Can you show us some studies that show evidence that anesthesia care is safer with an MD than a CRNA? If you can't, what you've said is just opinion.

(sorry guys, I just had to say it.)

there is no study out there that shows that driving with your feet is safer or as safe as driving with your hands.. But you can intuitively gather which one is safer....

Point is... more knowledge is better and safer.. and the physicians have more knowledge than a CRNA... even AA's have more knowledge than crnas// Name a crna school that requires One year of organic chemistry with a lab....

even AA's have more knowledge than crnas

you are talking out of your rectum

there is no study out there that shows that driving with your feet is safer or as safe as driving with your hands.. But you can intuitively gather which one is safer....

Point is... more knowledge is better and safer.. and the physicians have more knowledge than a CRNA... even AA's have more knowledge than crnas// Name a crna school that requires One year of organic chemistry with a lab....

Okay, 2 points. #1. Before starting school, I worked at Grady Memorial Hospital in Atlanta,GA ( A training site for Emory University's Anesthesiology/Patient Monitoring Systems Program). On more than 100 Occasions, a 2nd year AA student would get there 1ST!!! introduction to the ICU. Meaning ( " this is an A-line, this is a ventilator, this is a PA catheter, THIS IS A FOLEY :-). Its just hard to believe that less than a year away from graduating from this type of program, your just beginning to get exposed to lifesaving monitoring devices. Being that most CRNAs have had ICU experience before entering CRNA school, how can you say AAs have more education? Ignorance (meaning lack of knowledge). #2. Anyone heard of the ANESTHESIOLOGIST in chicago ( Cook County Medical Center ) who nasally intubated a patient for an emergent appy (why I don't know), didn't secure the tube properly and left the patient brain dead? The largest settlement in the history of Cook County 35 million dollars was awarded. It could have happen to anyone MD,CRNA, YMCA...doesn't matter. So are anesthesiologists more dangerous than CRNAs...no. Organic chemistry alone does not a better practitioner make.

The really funny part is that MDAs or DOAs can yell about safety all day, but as the amounts of op-out states increase...who is really listening. :-)

ok sigma.. if you are gonna make citations ... gimme a reference of that 35 million dollar law suit.. probably cant do it... all im trying to say is that IM looking out for the safety of the patient.. and dumbing down anesthesia by saying that you dont need to be a physician is dangerous. t his is a danger ous board...

Specializes in Anesthesia.
ok sigma.. if you are gonna make citations ... gimme a reference of that 35 million dollar law suit.. probably cant do it... ...

http://www.chicagotribune.com/news/local/chi-0510040185oct04,1,3100610.story

Antedeluvian indeed.

Okay, 2 points. #1. Before starting school, I worked at Grady Memorial Hospital in Atlanta,GA ( A training site for Emory University's Anesthesiology/Patient Monitoring Systems Program). On more than 100 Occasions, a 2nd year AA student would get there 1ST!!! introduction to the ICU. Meaning ( " this is an A-line, this is a ventilator, this is a PA catheter, THIS IS A FOLEY :-). Its just hard to believe that less than a year away from graduating from this type of program, your just beginning to get exposed to lifesaving monitoring devices. Being that most CRNAs have had ICU experience before entering CRNA school, how can you say AAs have more education? Ignorance (meaning lack of knowledge). #2. Anyone heard of the ANESTHESIOLOGIST in chicago ( Cook County Medical Center ) who nasally intubated a patient for an emergent appy (why I don't know), didn't secure the tube properly and left the patient brain dead? The largest settlement in the history of Cook County 35 million dollars was awarded. It could have happen to anyone MD,CRNA, YMCA...doesn't matter. So are anesthesiologists more dangerous than CRNAs...no. Organic chemistry alone does not a better practitioner make.

The really funny part is that MDAs or DOAs can yell about safety all day, but as the amounts of op-out states increase...who is really listening. :-)

Ooops - davvid, ya walked right into that little Cook County trap...

Sigma, although davvid2700 is a little over the top, you're both getting into that never-ending pi**ing match pretty quickly.

As far as your #2 - My personal favorite is the double-anesthesia-death at an abortion clinic in Atlanta about 25 years involving a single CRNA. Maybe you heard about it. Or a couple of SRNA-related anesthetic deaths at a now-closed Atlanta CRNA program. (and the Cook County patient wasn't left brain dead if you read the article) We all have our nightmare stories to relate involving any number and combination of types of anesthesia providers. It really doesn't do any of us much good to toss those out, but since you brought it up..... By and large, the vast majority of CRNA's, MD's, and AA's practice competently and safely day in and day out.

As far as your Grady Hospital experience.....at 25 students per class per year, not all of whom rotate through the Grady ICU, you must have been there for a longggggg time to see "more than 100 occasions". Somehow I doubt you were paying that close attention to students, but in any event, your claim is bogus on it's face anyway. The Grady ICU is NOT where AA's get our first exposure to a-lines, vents, foleys, etc., and it most certainly does not happen during the 2nd year of our program. Our clinical experience starts the very first week of the program, not at week 53.

I for one have never said that AA's have more education than CRNA's. It's different means to the same (or similar) end. There will always be differences between all three groups of providers, and all of us bring something to the table. Each group can rattle off pros and cons of the other two (or at least the more vocal and political of us do ;) ) All of us have a study to show how safe we are compared to the others. Yet again, the vast majority of us in all three groups practice our professions every day without managing to maim or kill our patients. Those of us who work in groups that have all three professions get along just fine (3 dozen of each in my practice). We work together, socialize together, and on occasion :eek: even administer an anesthetic to one of the others.

Specializes in Anesthesia.
.......All of us have a study to show how safe we are compared to the others. ......

Name one that shows CRNAs' anesthesia care to be inferior to MDAs'.

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