The Importance of a Title: Anesthesiologist vs. Nurse Anesthetist

[Melissa Mills]

Your job title probably means a lot to you.It might even be as important to you as your birth-given name. You went to school so that you could write specific letters behind your name, such as LPN, RN, or FNP. However, if you decided that it was easier to tell your patients that you were a caregiver, caretaker, or health assistant, would it matter? What if your preferred title was one that other professionals feel is reserved only for them?

For one advanced practice registered nurse, it mattered quite a bit. In fact, it was important enough for him to be able to call himself an anesthesiologist that he fought for this right in front of the Florida Board of Nursing.

Nurse Anesthetist vs. Anesthesiologist

John McDonough has identified himself to his patients as a nurse anesthesiologist for years. After recently appearing before the Florida Board of Nursing, McDonough can legally use this title. However, the Florida Society of Anesthesiologists doesn't agree with the decision. Chris Nuland, an attorney, and lobbyist for the organization told The News Service of Florida, "The FSA firmly believes that, although this declaratory statement only applies to this one individual, this sets a dangerous precedent that could confuse patients.”

McDonough didn't mince words regarding how he feels about his right to call himself an anesthesiologist. He was quoted in an article on nwfdailynews.com saying, "I'm not a technician. I am not a physician extender. I am not a mid-level provider. I am, in fact, a scientific expert on the art and science of anesthesia. So I think anesthesiologist is a perfectly acceptable term, especially since the term anesthetist has been hijacked from my profession.” He goes on to offer similar examples to his situation like dentists who identify as physician anesthesiologists.

Florida's Board of Nursing seems to make several statements about the role of advanced practice nurses these days. They are also deciding if advanced practice nurses can practice independently from physicians. Other nursing boards across the country are making critical decisions about the expansion of advanced practice nurses to work with greater autonomy. Given the continued expense of healthcare and the increased need due to an aging population, it only seems logical to allow these nurses more ability to work with less oversight.

Understanding the Role of the APN

It's essential to know that the term APN refers to several different types of nursing professionals. These various roles perform tasks such as diagnosing illnesses, performing head-to-toe physical exams, providing specialized exam such as functional and developmental testing, ordering lab tests, performing a variety of testing, and dispensing medications.

APN includes the following

• Certified Nurse Practitioner
• Certified Registered Nurse Anesthetist
• Certified Nurse Midwife
• Clinical Nurse Specialist

Advanced practice nurses have various levels of autonomy across the country. Some states allow APNs to operate clinics or offices independently. Other states require physician collaboration or supervision at all times. Because each type of APN has a different job description and role, the settings in which they practice and how they practice varies too. For example, a family nurse practitioner may work in an office with one or two MD's and only consult on cases as needed. For roles like a nurse anesthetist, the setting is likely larger, and they usually work with doctors and surgeons while performing their job functions.

What Do You Think?

So, what's in a name? Does it matter if you call yourself a nurse or caregiver? Should nurse anesthetists be limited to this term or should they be allowed to call themselves an anesthesiologist since this is the specialty for which they are certified? Let us know your thoughts by leaving a comment below.

[Nunya, BSN]

[MinasTurning]

Yes, and:

[globalwarrior]

Except that definition is incorrect as there are Dental Anesthesiologists, Veterinarian Anesthesiologists, Podiatric Anesthesiologists, Physician Anesthesiologists and Anesthesiologist Assistants in addition to Nurse Anesthesiologists.

[Codeman5788, MSN, APRN]

[MinasTurning]

One thing I know, there’s nothing more substantial than a Merriam Webster definition to make an argument. ??

[Hoosier_RN, MSN]

I don't really care about the title, as long as I get the appropriate care

[CommunityRNBSN, BSN, RN]

On 8/20/2019 at 10:39 PM, MinasTurning said:

The name of the article should probably be amended as the title in question is "Nurse Anesthesiologist" - not "anesthesiologist" alone.

I 100% agree with this. I have never worked anywhere near an OR and I’m not very familiar with these terms. If someone identifies himself as a “nurse anesthesiologist,” fine— I would understand that they are an APRN who is doing my anesthesia. I’ve never actually HEARD that term before but I can see how it makes sense. But that is very different from calling yourself an “anesthesiologist.” I think 99% of people who heard that term standing alone would believe you to be an MD/DO.

[Oldmahubbard]

On 8/20/2019 at 8:45 PM, zbb13 said:

Personally I think it’s wrong that nurses are attempting to use labels that other people have earned after years of education and attaining medical degrees, in addition to sacrificing even more years to specialize. It doesn’t sit well with me. Why can’t we be happy with what we have? Why do we insist on being called something we are not?

But how are people with fewer years of education doing the same job, and getting the same outcomes? What does it all mean?

[MinasTurning]

40 minutes ago, CommunityRNBSN said:

I 100% agree with this. I have never worked anywhere near an OR and I’m not very familiar with these terms. If someone identifies himself as a “nurse anesthesiologist,” fine— I would understand that they are an APRN who is doing my anesthesia. I’ve never actually HEARD that term before but I can see how it makes sense. But that is very different from calling yourself an “anesthesiologist.” I think 99% of people who heard that term standing alone would believe you to be an MD/DO.

Agreed on most of this. Though, the research from the ASA would suprise you. The public doesn't have the same lens that we in the health care community does:

https://www.nurseanesthesiologistinfo.com/research

[MinasTurning]

35 minutes ago, Oldmahubbard said:

But how are people with fewer years of education doing the same job, and getting the same outcomes? What does it all mean?

In all honesty the two professions are not identical (obviously) but there is a significant overlap in services, and the anesthesia scope of services is identical, although there are of course local variations.

In terms of volume of education, it's pretty straight forward. More does not equal better.

As a society we have to think in terms of value, not just who has the most (or "best" initials). Both MDAs and CRNAs create a lot of value. This movement is simply meant to showcase that value, and to get past a lot of misconceptions.

[CommunityRNBSN, BSN, RN]

3 minutes ago, MinasTurning said:

Agreed on most of this. Though, the research from the ASA would suprise you. The public doesn't have the same lens that we in the health care community does:

https://www.nurseanesthesiologistinfo.com/research

That is super interesting.

The terminology is IMPOSSIBLE for most laypeople. One conversation I have a lot goes like this:

Me: Oh ok, I understand, you are saying that you need anti-depressants. Do you see a psychiatrist?

Pt: Yeah, every Friday, Dr Smith.

Me: Is Dr Smith a psychiatrist?

Pt: You know, he’s a doctor, we talk for 45 minutes every week but he’s never mentioned anything about medicine, I don’t think he does that

Me: Ohhh I see, he’s probably the OTHER kind of doctor, who is a doctor but not a medical doctor...

Similar conversations re Optometrist vs Optician vs Ophthalmologist, Physician Assistant vs Medical Assistant, APRN vs RN vs CNA...It’s a mess.

[Ummmmmm]

On 8/20/2019 at 5:11 PM, subee said:

This is an arcane issue amongst the CRNA's now because the next guys down on the food chain, anesthesiology assistants, are now calling themselves anesthetists. "Anesthesiology " merely means the mastery of the science of anesthesia. CRNA's have much more classroom experience compared to MD's who learn their tradecraft through apprenticeships. It just kills so many of the MD's that CRNA's are independent practitioners that they created their own layer of provider, the anesthesia assistant, who must be physically supervised by the MDA. These folks have no prior medical or nursing experience and do not add to cost effectiveness. It's all about controlling the billing. I can say from 31 years if experience that, as a rule, MDA's are an extremely greedy group if practitioners. G_d forbid that you run up to OB to do a difficult IV and dont fill out a billing form. Geez. Things I always did for free in the olden times when I worked without an anesthesiologist. I'm not one of those people who thinks I can do everything alone. We need anesthesiologists but just not so many of them. 90% if the cases are bread and butter and can be done independently by CRNA's. But I've noticed in the past decades that CRNA students don't want the responsibility of working alone and are content to be supervised in a team situation.

Ummm, you DO realize that there are CRNAs with only an associates degree in nursing and no master's of anesthesia right? That for the first 40 something years of CRNAs existence you didn't even need a master's degree right? Thats anyone before 1998 for those unaware.... And that AAs have ALWAYS required a pre-med undergrad degree AND a master's degree? That a pre-med undergrad degree is WAY more heavy in basic sciences and physiology than a nursing degree, right? And just because your massive political lobby has snatched you up some additional practice rights in select areas, that it doesn't make your training any more substantial than it really is right?

Even though you think you're 'higher up the food chain'.....You do know all this, yeah?

Just wondering....