The Importance of a Title: Anesthesiologist vs. Nurse Anesthetist
When you think of the terms anesthesiologist and nurse anesthetist, do you view them as the same or different? One APN argues that they are the same and he should be able to use either one to describe his role to his patients. Learn more and let us know if you agree.
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.
You don't need a Pre-Med degree to get into AA school. Any Bachelor degree will do and just as in nursing school you need certain science classes. That is true that some CRNA's have been grandfathered prior to requiring a Masters and now a Doctorate degree for all future CRNA's. However, that also means that they have decades more experience than any other new grads including AA's, CRNA's and MDA's. The AA role was not even created until the 1970's. There are also PA's still practicing with only an Associates degree or a certificate. The fact is that CRNA's are trained to be able to practice independently, while AA's were created to be subordinates to other Anesthesia providers.
The fact is that CRNA's are trained to be able to practice independently, while AA's were created to be subordinates to other Anesthesia providers.
I think y'all must be trained on this phrase during CRNA school. Do you recite it like the pledge each day in class? I've heard a bunch of you say it, and have never heard a shred of evidence as to what you actually think it means in practicality. AAs have a heavier science background than CRNAs in undergrad.....check for the AAs. We both get master's degrees in anesthesia....check for both AAs and CRNAs. However, AAs, have higher requirements as far as case numbers and clinical hours during our masters degrees, so maybe another check for AAs.
Sooooooo, where exactly are you learning independence vs AAs subordinance??? Must be during that one year as an RN adjusting pumps and changing bedpans...
I think y'all must be trained on this phrase during CRNA school. Do you recite it like the pledge each day in class? I've heard a bunch of you say it, and have never heard a shred of evidence as to what you actually think it means in practicality. AAs have a heavier science background than CRNAs in undergrad.....check for the AAs. We both get master's degrees in anesthesia....check for both AAs and CRNAs. However, AAs, have higher requirements as far as case numbers and clinical hours during our masters degrees, so maybe another check for AAs.
Sooooooo, where exactly are you learning independence vs AAs subordinance??? Must be during that one year as an RN adjusting pumps and changing bedpans...
If you are an AA, could you please explain to me your job functions? I have never heard of this practice. Thank you.
I am not a CRNA, but I know a few of them and have been in healthcare for decades. There are 2 paths to become a CRNA. You can get a 4-year Bachelors degree plus a 2 year BSN or MSN, then 2+ years in ICU, then 3 year Doctorate in Anesthesia. The other way is 4-year Bachelors degree in Nursing. Then 2+ years in critical care (ICU) then 3 more years for a Doctorate in Aneathesia (plus sometimes a Fellowship). For AA it us 4 year degree then a 2 year Masters. No experience required.
AAs don't understand and never will because they are not independent practitioners and never will be. ALL APRNs, including CRNAs, are trained to function as independent practitioners. AAs are not premed. it is not a requirement. They can have a degree in basket weaving and then take a few science courses and get accepted into school. AAs future also depends on physician anesthesiologist being around in the future so of course they are going to suck up to them.
Here is a comparison below between CRNAs and AAs. It’s a few years out of date, but still overall relevant. There is no requirement for any specific degree to get into AA school. AAs are not better educated nor do they do more clinical hours. AAs like anesthesiologists residents calculate their total time in the hospital unlike CRNAs who only calculate their time in the OR even when doing speciality rotations such as OB.
As far as the topic goes the term nurse anesthesiologist first appeared in the early 1900s.
I found it ironic no medical association had an issue when there was physician anesthesiologists, dental anesthesiologists, veterinary anesthesiologists or how anesthesiologist assistants have been using the title Anesthetists for years, but when nurses start using the term nurse anesthesiologist suddenly this endangers patients. It is the same lie about APRNS that medical associations have been using for years.
I am not a CRNA, but I know a few of them and have been in healthcare for decades. There are 2 paths to become a CRNA. You can get a 4-year Bachelors degree plus a 2 year BSN or MSN, then 2+ years in ICU, then 3 year Doctorate in Anesthesia. The other way is 4-year Bachelors degree in Nursing. Then 2+ years in critical care (ICU) then 3 more years for a Doctorate in Aneathesia (plus sometimes a Fellowship). For AA it us 4 year degree then a 2 year Masters. No experience required.
This entire subject brings to mind a recent observation I made when accompanying someone at a visit(s) to the ER recently. They waited a very long time to be treated by physician assistants (for which they subsequently received some hefty bills). The registered nurses (and in at least one case NP) who interacted, offered the person a blanket, stated they would be their "nurse", and/or did some charting on a mobile device. But the long wait to get anything accomplished was for a physician assistant. My thoughts: why couldn't a nursing assistant have offered the blanket? None of this set well with me and I see the conversation about CRNA and MDA in the same light, although I know it is different. If this is my impression, I wonder what the public, with somewhat less background, will think of it. It really is up to the professions to make all of this clear and to act accordingly. The person I was accompanying thought they were being treated by a doctor and had no idea the person offering them the blanket was a nurse, until it was stated. The word "handmaiden" comes to mind. Not the image I think we want to project. So, how to distinguish a CRNA from an MDA? And to explain what each does or does not do?
Thanks so much for this info. I had no idea AAs existed.
So....if you're truly wanting facts on these two professions, you're not in the right place. Unless you want to be indoctrinated by the CRNAs here into believing that AAs are mere assistants and that CRNAs are somehow anesthesiologists in disguise.
The brass tacks are this.
Undergrad
AA - 4 years undergrad which are very heavy in science, most ARE in fact pre-med students that decide not to take that route.
CRNAs - 4 year BSN, less heavy in true science and more heavy in in nursing theory, etc.
Look anywhere you want to verify, but nursing classes are not as rigorous as pre-med science courses. That's just a fact.
Applying to school
AA - You can go right into AA school after undergrad, but many work as EMTs, RTs, NURSES (shocking, I know), or other various healthcare fields prior to their masters. Fun fact - One of my good friends is an RN turned AA. AAs are required to take the MCAT or GRE, depending on the program.
CRNA - You are required to do one year of critical care nursing for CRNA school, and many nurses apply to school prior to completion of that year. GRE for application, no MCAT
*The fact that CRNAs all do work for at least a year as an RN gives them a head start on drug names, basic mechanisms of action, and just how to function in the hospital. That's undeniable. But after a short adjustment period for AAs (read ~6 months into clinicals), that's really not a big deal in practicality.
AA/CRNA Degrees
AAs have always required a master's degree since the inception of the field in the 60s.
CRNAs were originally a certificate degree, then just a bachelors. In 1998 they started requiring a MS degree, so there are many CRNAs today that have much less formal training than current AAs. And come 2025 CRNAs are inflating their degree requirement to a doctorate degree to try and give themselves more clout against the MDs in the public eye.
In my opinion it a joke of a "doctorate" as its minimal more schooling and not any additional clinical training. Most of it can be done online! LOL
"Most Master degree programs are 28 to 30 months in length; in reality, you will only spend 6-8 more months in college to achieve the DNP"
and...
"Many DNP programs offer the first year online and allow full-time employment as a nurse during this year. Schools recognize that 36 months of full-time study is a long commitment, and are trying to make the first year a transition that will allow students to continue working so they can have more savings and an easier time the last two years. This means that while you may have to balance work and school for a while, you will only be out of work two years as opposed to three."
So yeah, don't believe the false equivalence when they start spouting, "Well CRNAs and Anesthesiologists are both doctors and AAs only have a masters degree!"
Practice
As I mentioned in an earlier post, there are areas of the country where the AANA has lobbied for independent practice, mostly in rural areas, but that's not the norm. The majority of CRNAs practice in the care team model, just like AAs do. In the same practice, AAs and CRNAs usually have the exact same responsibility, the same pay, the same everything. That's just reality.
To summarize, if you have a nursing background, go CRNA for sure. You can practice in all 50 states, while AAs are only in 30ish states. That will eventually become all 50, but why limit yourself if you dont have to. If you already have bachelors degree with all the required science classes, go AA. It'd be a waste of time to go get a 2 year bachelors and work for a year in the ICU just to apply to CRNA school. Both schools turn out quality providers. However, I will say that there is much more consistency with the quality of AAs that are put out due to the limited number of schools. I think its less than 15 programs, whereas there are 100+ CRNA schools. Big difference between an army trained CRNA and some pop up CRNA school degree mill. Just saying.
Also, even though arguments online tend to get kind of feisty, I have no problem with most CRNAs. I work with a bunch of em, as our group is about 50/50 AA/CRNA. Most of them are very friendly and well trained, and would say the same about AAs. Its just the militant murses turned CRNAs who wanna pretend that they're doctors, and try and deceive the public into believing that AAs merely hand the docs drugs or something that chaps my hide. Here's lookin' at you Mike ?
Sooooooo, where exactly are you learning independence vs AAs subordinance??? Must be during that one year as an RN adjusting pumps and changing bedpans...
You can't expect to have a productive conversation where everyone on all sides can learn from each other when you are starting from a place of such ignorance. That place being that nursing is adjusting pumps and changing bedpans.
This is a professional conversation and has remained respectful until this comment came along. If you really want people to understand your scope of practice and level of education, then you need a different approach, my fellow medical professional. And pro tip: nothing reeks more of insecurity than such defensiveness. To me, if one is truly confident in his/her scope, knowledge and expertise, then one does not need to be so defensive in such a rude, condescending way. So again, try a different approach if you really want to educate.
globalwarrior
5 Posts
You don't need a Pre-Med degree to get into AA school. Any Bachelor degree will do and just as in nursing school you need certain science classes. That is true that some CRNA's have been grandfathered prior to requiring a Masters and now a Doctorate degree for all future CRNA's. However, that also means that they have decades more experience than any other new grads including AA's, CRNA's and MDA's. The AA role was not even created until the 1970's. There are also PA's still practicing with only an Associates degree or a certificate. The fact is that CRNA's are trained to be able to practice independently, while AA's were created to be subordinates to other Anesthesia providers.