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.

[Oldmahubbard]

I had two brief ambulatory procedures last year and nobody introduced themselves.

I would have been fine with a CRNA.

[Travel_RN_0714, MSN, RN]

3 hours ago, Undercat said:

Sorry but I would have been taken to task for not introducing myself in some vague catagory like that. That's a sloppy practice. Besides we have our names and category on our scrubs at the mothership and have to wear ID everywhere else. Over the years I have had about 3 patients who refused care from a CRNA and we always sent them the youngest, rawest resident we could find to replace me or tell the patient they would have to move to the end of the day when an MDA was freed up.

Talk about sloppy practice. CRNA's like you and your arrogance is what's wrong with the medical profession. If you ever tried moving a patient to the end of the surgical day over an IV start, some of the Orthopedic Surgeons I've worked with would chew you a new a**. Nice story, but I don't believe you for one second.

[beachbabe86]

You said EXACTLY what I was going to reply. Last time I checked the surgeons were in charge of their own schedule, not some staff CRNA. Wow.

[wtbcrna, MSN, DNP, CRNA]

6 hours ago, Travel_RN_0714 said:

Talk about sloppy practice. CRNA's like you and your arrogance is what's wrong with the medical profession. If you ever tried moving a patient to the end of the surgical day over an IV start, some of the Orthopedic Surgeons I've worked with would chew you a new a**. Nice story, but I don't believe you for one second.

What are you two talking about? Undercat stated if the patient requested an MDA and one wasn’t available then the patient was told they would have to be moved to the end of the day until an MDA was available.
Surgeons surgical schedules get moved around all the time by other people, and in this case the CRNA technically would have been the one implementing based on patient refusal to have a CRNA do their anesthesia.
I’m not sure where you got onto another tangent with undercats statement.

[NICU_Nurse_Casti, BSN, RN]

My professor (who sits on the FL BoN) just sent me this:

“Lawmaker takes aim at health care titles” via Christine Sexton of the News Service of Florida — State Rep. Ralph Massullo, a dermatologist from Lecanto, has filed a bill for the 2020 Legislative Session that would change state law and allow health-care licensing boards to take disciplinary action against providers who are not physicians but use monikers that could imply they are, such as “anesthesiologist.” The bill (HB 309) comes on the heels of a unanimous decision by the Florida Board of Nursing in August to allow John McDonough, an advanced practice registered nurse, to identify himself as a “nurse anesthesiologist” without facing repercussions. Massullo’s bill would amend health care professional licensure laws to define anesthesiologists as allopathic or osteopathic physicians who have completed anesthesiology training programs.

Just thought it was interesting since this thread started because of Dr. McDonough and his request to use “nurse anesthesiologist” to describe himself.

[Subee2, BSN, MSN, CRNA]

On 10/9/2019 at 2:08 AM, wtbcrna said:

What are you two talking about? Undercat stated if the patient requested an MDA and one wasn’t available then the patient was told they would have to be moved to the end of the day until an MDA was available.
Surgeons surgical schedules get moved around all the time by other people, and in this case the CRNA technically would have been the one implementing based on patient refusal to have a CRNA do their anesthesia.
I’m not sure where you got onto another tangent with undercats statement.

Thank you wtbcrna: I have no idea what these people are talking about!

[wtbcrna, MSN, DNP, CRNA]

5 hours ago, CastiMcNasti said:

My professor (who sits on the FL BoN) just sent me this:

“Lawmaker takes aim at health care titles” via Christine Sexton of the News Service of Florida — State Rep. Ralph Massullo, a dermatologist from Lecanto, has filed a bill for the 2020 Legislative Session that would change state law and allow health-care licensing boards to take disciplinary action against providers who are not physicians but use monikers that could imply they are, such as “anesthesiologist.” The bill (HB 309) comes on the heels of a unanimous decision by the Florida Board of Nursing in August to allow John McDonough, an advanced practice registered nurse, to identify himself as a “nurse anesthesiologist” without facing repercussions. Massullo’s bill would amend health care professional licensure laws to define anesthesiologists as allopathic or osteopathic physicians who have completed anesthesiology training programs.

Just thought it was interesting since this thread started because of Dr. McDonough and his request to use “nurse anesthesiologist” to describe himself.

I think the most important thing to see about that bill is that it was introduced by a physician/dermatologist.

[Subee2, BSN, MSN, CRNA]

On 10/8/2019 at 11:43 PM, beachbabe86 said:

You said EXACTLY what I was going to reply. Last time I checked the surgeons were in charge of their own schedule, not some staff CRNA. Wow.

Do you and Travel_RN lurk on this thread just to spread vitriol? You have no idea what I am talking about but just couldn't resist spewing. Geez.

[NICU_Nurse_Casti, BSN, RN]

10 hours ago, wtbcrna said:

I think the most important thing to see about that bill is that it was introduced by a physician/dermatologist.

Would you please elaborate? What point are you trying to make?

[wtbcrna, MSN, DNP, CRNA]

31 minutes ago, CastiMcNasti said:

Would you please elaborate? What point are you trying to make?

The point is simple. It’s about politics between nurses/APRNS and physicians. That is why it’s a physician introducing the bill to try to protect physician egos and to continue to make people think that only physicians have doctorates in the hospital.

[NICU_Nurse_Casti, BSN, RN]

12 minutes ago, wtbcrna said:

The point is simple. It’s about politics between nurses/APRNS and physicians. That is why it’s a physician introducing the bill to try to protect physician egos and to continue to make people think that only physicians have doctorates in the hospital.

I do not know if it is to protect physician's egos. I do believe it is to help protect physicians and providers, alike. I think it is safe to assume the general public does not fully understand the differences between the various advanced practice providers and physicians. If APRNs begin to describe themselves to patients using monikers traditionally used for physicians, there could be confusion among the patients. I am thinking this could lead to legal problems if treatment should not go well (i.e. misleading or misinforming the patient of your true credentials). Just a thought. I am not aware if there is any legal precedence for such a thing.

I also do not feel it is to make people think only physicians have "doctorates." Your education is your education. Nobody can take that away. But let's be honest. In the healthcare setting (and often times in public situations), when someone refers to themselves as "Doctor so-and-so", people think of a medical doctor. This is not to say APRNs or PAs cannot be as effective as physicians. I am not trying to downplay the importance of and effectiveness of APRNs.

I think the more important thing to take away from this house bill is Dr. McDonough may have increased the tension between APRNs and physicians (as this thread has made obvious there is at least some already) and possibly harmed the working relationship. After thinking about it for some time, I personally feel Dr. McDonough was attempting to feed and protect his own ego with wanting to describe himself as a "nurse anesthesiologist." Dr. McDonough's request was in response to AA's using the term "anesthetist." I think it's a reasonable response by physicians to want to protect their title and all they have worked for when another provider has done a similar thing to them. A friend of mine said she started working as a patient tech, followed by "I am basically a nurse." What do you think would happen if CNAs or Patient Techs starting fighting to use a moniker that may insinuate they are Registered Nurses? Would nurses be "protecting their ego" to fight against something like that? APRNs, PAs, MDs, DOs, and any other advanced practice provider all bring something to the table. Instead of fighting each other about who gets more training in a specialty, who achieves better outcomes, who deserves what title, etc., we should be working together to improve healthcare delivery. Anyway, those are my thoughts.

[wtbcrna, MSN, DNP, CRNA]

4 hours ago, CastiMcNasti said:

I do not know if it is to protect physician's egos. I do believe it is to help protect physicians and providers, alike. I think it is safe to assume the general public does not fully understand the differences between the various advanced practice providers and physicians. If APRNs begin to describe themselves to patients using monikers traditionally used for physicians, there could be confusion among the patients. I am thinking this could lead to legal problems if treatment should not go well (i.e. misleading or misinforming the patient of your true credentials). Just a thought. I am not aware if there is any legal precedence for such a thing.

I also do not feel it is to make people think only physicians have "doctorates." Your education is your education. Nobody can take that away. But let's be honest. In the healthcare setting (and often times in public situations), when someone refers to themselves as "Doctor so-and-so", people think of a medical doctor. This is not to say APRNs or PAs cannot be as effective as physicians. I am not trying to downplay the importance of and effectiveness of APRNs.

I think the more important thing to take away from this house bill is Dr. McDonough may have increased the tension between APRNs and physicians (as this thread has made obvious there is at least some already) and possibly harmed the working relationship. After thinking about it for some time, I personally feel Dr. McDonough was attempting to feed and protect his own ego with wanting to describe himself as a "nurse anesthesiologist." Dr. McDonough's request was in response to AA's using the term "anesthetist." I think it's a reasonable response by physicians to want to protect their title and all they have worked for when another provider has done a similar thing to them. A friend of mine said she started working as a patient tech, followed by "I am basically a nurse." What do you think would happen if CNAs or Patient Techs starting fighting to use a moniker that may insinuate they are Registered Nurses? Would nurses be "protecting their ego" to fight against something like that? APRNs, PAs, MDs, DOs, and any other advanced practice provider all bring something to the table. Instead of fighting each other about who gets more training in a specialty, who achieves better outcomes, who deserves what title, etc., we should be working together to improve healthcare delivery. Anyway, those are my thoughts.

You need to go back and read the whole thread before responding. Each one of your comments has already been addressed. I’ll recap though: 1. The title of Nurse anesthesiologists goes back till at least the 1950s. 2. There are dental anesthesiologists, veterinary anesthesiologists, physician anesthesiologists, and nurse anesthesiologists. It is only when CRNAs use the title nurse anesthesiologist that you suddenly hear the argument of patient confusion and other nonsense. 3. The term anesthesiologist is obviously not a protected title as other non-physician anesthesiologists have used it for years. 4. Physicians not CRNAs have for years sought to obscure and confuse the public about the title anesthetist, and now when the title Nurse anesthesiologists has been revived they are upset. 5. This is nothing more than a power struggle between APRNs and physicians. Physicians want to keep APRNs obscure and under their supervision. This is done to keep their wallets fat and egos inflated. It doesn’t matter if you agree or not you can see this by workplace arrangements, unnecessary state laws that do nothing for patient safety but keep MDAs out of the OR while increasing their salaries off the work of CRNAs. 6. Each provider should be allowed to practice to their full scope of practice that is something physicians have fought for over 100 years and CRNAs addressing themselves as Nurse anesthesiologists is part of that ongoing struggle.