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.

[Ummmmmm]

Oh lighten up. The bedpan thing was just a jab, sheesh. Kind of akin to talking about AAs as "down the food chain" from CRNAs.

I'm very confident in my role and abilities. As is my chair of anesthesia who, for some silly reason, pays me the same as my CRNA colleagues, despite me being down the food chain from them.

Did you read my very detailed and fact filled comment to the person who hadn't ever heard of AAs? Or my statement about how I like and appreciate MOST of the CRNAs I've ever met?

[Mariann Aiello Trice]

I am a CRNA. I’ve worked in a care team model and now work independently. I’m not sure what question you are asking but I work independently in WA as a licensed independent provider of anesthesia. I am not supervised by an anesthesiologist (there are none in my practice) nor am I supervised by a physician. I carry my own malpractice, perform my own pre-ops, anesthetics, ultrasound-guided regional, have a DEA license and manage my pt in PACU through discharge. And no, my patients are not all ASA 1 and 2’s. They are sometimes obese, diabetic, CAD, HTN, and with diffficult airways. Last I checked, an AA can ONLY work in a care team. So, the issue is CRNAs are safe, cost-effective and improve access to care. I am not a physician nor do I pretend to be one. But, I do bring value to the table that an AA can not. Period. I have nothing against AAs or Physician anesthesiologists. We all have value and a role. Promoting my own profession does not diminish others’.

[wtbcrna, MSN, DNP, CRNA]

3 minutes ago, Ummmmmm said:

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

This is from http://www.all-crna-schools.com/why-you-should-get-your-dnp-now/

"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.

Hope that's helpful.

I

Brass Tacks:

AAAA (American Association of AAs) is a subsidiary of the ASA. They are assistants and under anesthesiologists as an organization/professionally and cannot work without a physician anesthesiologist. AAs are designed to only work in ACT practices under direct supervision of anesthesiologists. AAs will never practice independently most will never learn and do PNBs or CVLs or anything other than sit and monitor patients. AAs will rarely if ever manage the “board”, they are unlikely (and actually are not supposed to) be the independent sole preoperative or postoperative evaluators of their own patients (if they are they are they are supposed to have an anesthesiologist sign off on their charts to verify the information).

Prerequisites for AAs.

“Baccalaureate degree from a regionally accredited institution

One semester of English

Two semesters of general biology with laboratory

Two semesters of general chemistry with laboratory

One semesters of human anatomy with cadaver or virtual laboratory OR two semesters of an anatomy and physiology combined course with laboratory (Emory does not accept vertebrae anatomy)

One semester of organic chemistry with laboratory

One semester biochemistry

Two semesters of general physics

One semester of calculus” from Emory.

To get in undergraduate nursing school (BSN):

General Chemistry, Anatomy and Physiology (2 semesters), Statistics, Microbiology, Nutrition, Sociology, Psychology.

Then in nursing school you take pharmacology, pathophysiology, health assessment, and myriad of other courses that teaches physiology and pathophysiology for each age group plus OB, mental health etc. Nurses learn and become proficient in basic health care at the undergraduate level that AAs have to learn during didactic.

To get in CRNA school you will need to have at least 1 year of experience working in critical care with the average student having 3-5 years. You will to have your advanced and pediatric advanced life support certifications, GRE, biochemistry and/or organic chemistry. There is no formal requirement physics or calculus (I had taken both prior to going to anesthesia school and there is nothing in either of those classes that you specifically need for anesthesia training). There are none of these certifications or experiences that are required for AAs. AAs are overall lay people being taught patient care for the first time whereas CRNA students will have been taking of patients for a bare minimum of 3 years prior to starting school, and most will have been giving patient care for 5-7 years.

The training and licensure speak for themselves. CRNAs can and do work independently. CRNAs are interchangeable with physician anesthesiologists whereas AAs can only work under the direction of physician anesthesiologists, if that is ever a question between AA and CRNA ability to practice just ask: Where are all the AA only practices and why aren’t AAs allowed to practice in the military?

The majority of anesthesia practices are no longer ACT practices that changed several years ago. CRNAs can and do work independently in every state and US territory. It is approximately 85% independent CRNA practices in rural areas and about 60-65% in urban areas. AAs will never see this for themselves because they cannot work in those places.

[Orion81RN]

24 minutes ago, wtbcrna said:

Brass Tacks:

AAAA (American Association of AAs) is a subsidiary of the ASA. They are assistants and under anesthesiologists as an organization/professionally and cannot work without a physician anesthesiologist. AAs are designed to only work in ACT practices under direct supervision of anesthesiologists. AAs will never practice independently most will never learn and do PNBs or CVLs or anything other than sit and monitor patients. AAs will rarely if ever manage the “board”, they are unlikely (and actually are not supposed to) be the independent sole preoperative or postoperative evaluators of their own patients (if they are they are they are supposed to have an anesthesiologist sign off on their charts to verify the information).

Prerequisites for AAs.

“Baccalaureate degree from a regionally accredited institution

One semester of English

Two semesters of general biology with laboratory

Two semesters of general chemistry with laboratory

One semesters of human anatomy with cadaver or virtual laboratory OR two semesters of an anatomy and physiology combined course with laboratory (Emory does not accept vertebrae anatomy)

One semester of organic chemistry with laboratory

One semester biochemistry

Two semesters of general physics

One semester of calculus” from Emory.

To get in undergraduate nursing school (BSN?

General Chemistry, Anatomy and Physiology (2 semesters), Statistics, Microbiology, Nutrition, Sociology, Psychology.

Then in nursing school you take pharmacology, pathophysiology, health assessment, and myriad of other courses that teaches physiology and pathophysiology for each age group plus OB, mental health etc. Nurses learn and become proficient in basic health care at the undergraduate level that AAs have to learn during didactic.

To get in CRNA school you will need to have at least 1 year of experience working in critical care with the average student having 3-5 years. You will to have your advanced and pediatric advanced life support certifications, GRE, biochemistry and/or organic chemistry. There is no formal requirement physics or calculus (I had taken both prior to going to anesthesia school and there is nothing in either of those classes that you specifically need for anesthesia training). There are none of these certifications or experiences that are required for AAs. AAs are overall lay people being taught patient care for the first time whereas CRNA students will have been taking of patients for a bare minimum of 3 years prior to starting school, and most will have been giving patient care for 5-7 years.

The training and licensure speak for themselves. CRNAs can and do work independently. CRNAs are interchangeable with physician anesthesiologists whereas AAs can only work under the direction of physician anesthesiologists, if that is ever a question between AA and CRNA ability to practice just ask: Where are all the AA only practices and why aren’t AAs allowed to practice in the military?

The majority of anesthesia practices are no longer ACT practices that changed several years ago. CRNAs can and do work independently in every state and US territory. It is approximately 85% independent CRNA practices in rural areas and about 60-65% in urban areas. AAs will never see this for themselves because they cannot work in those places.

According to our guest on this site, 6 months of clinical experience equates to those 5-7 years of prior patient care as an RN. ?

[Ummmmmm]

Yawn.

The VAST majority of stuff learned in nursing school ain't got a whole lot to do with anesthesia. Just sayin'...

Why do the majority of y'all hold the same role that we do across the country, for the same pay, same benefits, schedules, responsibilities, liabilities, etc???

Must be demeaning for you to be treated the same as us sub-par providers.

[Ummmmmm]

It's the same thing as PAs and NPs...

If a huge political lobby acquires some practice rights for you, that doesn't change any reality in your intelligence or abilities. You honestly think a bachelors in nursing somehow enables this ability to independent practice down the road?......HONESTLY?

'Cause that's the only difference in training.

And I LOVE the RNs I work with, but nothing about their training promotes independent medical decision making. Sorry.

[wtbcrna, MSN, DNP, CRNA]

3 hours ago, Ummmmmm said:

Yawn.

The VAST majority of stuff learned in nursing school ain't got a whole lot to do with anesthesia. Just sayin'...

Why do the majority of y'all hold the same role that we do across the country, for the same pay, same benefits, schedules, responsibilities, liabilities, etc???

Must be demeaning for you to be treated the same as us sub-par providers.

Were you a nurse prior to going to AA school, if not then how do you know that the “vast majority” of it doesn’t have to do with anesthesia.?

The majority of CRNAs dont work with AAs or in ACTs. CRNAs salaries are higher on average than AAs. The only time AAs and CRNAs have similar pay is when CRNAs work in restrictive ACT practices. You wouldn’t know what other anesthesia are like because you cannot work in them. You only know what the ASA tells you to believe.

I wouldn’t know how CRNAs feel that work in ACT practices because like most CRNAs I refuse to work in that type of practice.

[wtbcrna, MSN, DNP, CRNA]

4 hours ago, Ummmmmm said:

It's the same thing as PAs and NPs...

If a huge political lobby acquires some practice rights for you, that doesn't change any reality in your intelligence or abilities. You honestly think a bachelors in nursing somehow enables this ability to independent practice down the road?......HONESTLY?

'Cause that's the only difference in training.

And I LOVE the RNs I work with, but nothing about their training promotes independent medical decision making. Sorry.

RNs that have worked in critical care have all known what it’s like to work independently. It’s part of the job to independently evaluate your patients and know when to consult or manage the patient within the parameters set.

AAs have to learn basic health assessments as part of their curriculum. AAs receive zero clinical rotations in independent practices. It’s unusual for AAs to do/learn PNBs, CVLS, how to manage the preoperative to postoperative patient independently, AAs don’t learn to pull call as independent provide.

There are huge differences in expectations, training and backgrounds between AAs and CRNAs.

Why is it that the military uses physician anesthesiologists and CRNAs interchangeably, if there is this vast difference that you suggest between the two.

Why is it if CRNAs and AAs, as you suggest, are so similar AAs cannot work independently?

AAs exist for the sole reason of physician anesthesiologists to try and control the anesthesia market, if all anesthesia practices converted to independent practices tomorrow you could eliminate all AAs and there could end anesthesia provider shortage.

[Ummmmmm]

So the MAJORITY of CRNAs practice independently and not in the care team huh?

That's interesting, considering CRNAs are only able to practice independently in 1/3 of the states in the US. Hmmmmmmm.....

Its just shocking that y'all claim such superiority above AAs and yet claim equivalence to MDs/DOs, when whatever gap in training you think there is between CRNAs and AAs is so minute compared to the gap between CRNAs and MDs. Yet you so emphasize the small gap, and trivialize the giant one.

[Subee2, BSN, MSN, CRNA]

39 minutes ago, Ummmmmm said:

So the MAJORITY of CRNAs practice independently and not in the care team huh?

That's interesting, considering CRNAs are only able to practice independently in 1/3 of the states in the US. Hmmmmmmm.....

Its just shocking that y'all claim such superiority above AAs and yet claim equivalence to MDs/DOs, when whatever gap in training you think there is between CRNAs and AAs is so minute compared to the gap between CRNAs and MDs. Yet you so emphasize the small gap, and trivialize the giant one.

In this case you are correct: Most CRNA's do practice in ACT's. However, you are wrong to equate the ability to work "independently" in only 1/3 or the states. That number have moved up and recent years and that term refers only to the ability to bill. Even if you are not allowed to bill independently, you can work in offices with "supervision" coming from the doc you are working with. You sound very young and testosterone toxic.

The fact is that we are not REQUIRED to work under the thumb of an anesthesiologist. And I've worked with many MDA's in NYC who went to "prestige" colleges and med schools, but didn't have a lick of the common sense that anesthesia relies on. Getting an A on Ochem does not transfer to making good split level decisions on our own because you can't depend on the incompetent MDA you are assigned to that day to help. I worked independently, after 5 pm and on weekends, right out of anesthesia school scared %@(#less to have to conduct anesthetics on my own, especially spinals and epidurals in OB. AA's don't have to experience the rigors of being on your own in the middle of the night when a patient comes in with a stab wound that went through the aorta AND the vena cava. So, stop being so juvenile and childish. Grow up and play like an adult.

[Codeman5788, MSN, APRN]

AAs are not capable of practicing independently and never will. PERIOD. Doesn't matter what you say or how you feel about it. CRNAs CAN and DO practice without a physician anesthesiologist in 49/50 states. Live with it.

[Subee2, BSN, MSN, CRNA]

16 hours ago, Ummmmmm said:

Yawn.

The VAST majority of stuff learned in nursing school ain't got a whole lot to do with anesthesia. Just sayin'...

Why do the majority of y'all hold the same role that we do across the country, for the same pay, same benefits, schedules, responsibilities, liabilities, etc???

Must be demeaning for you to be treated the same as us sub-par providers.

And your undergraduate degree in basket-weaving teaches you a whole lot about anesthesia? I just posted about being able to work independently as a new grad and just want to add that I could do that because of the TEN years of nursing experience that I brought to the table. What does taking the MCAT's have to do with being competent. I took the MCAT when I applied to med school but it is just a more tedious SAT. Just because you do well on it doesn't mean you can make good choices. You must have not worked in this business very long because we seem to attract the MDA'a who are lazy, greedy and don't give a damn about actually doing the art of anesthesia themselves. I know that's a broad brush, but there is a lot of truth to it because I was always so relieved to know that on any particular day the attending was going to let me do what I do without interference and, if I needed help, was going to get that tube in that 50 lb. pumpkin head full stomach because I didn't want to hurt my neck again. Those guys were more likely the outliers.