What is up with CRNA/AA/MDA politics.

[dreatx]

I am way not in it but long term, i am aspiring to be a CRNA so i hang out on various boards and i am amazed at what i see. I see MDAs to be talking about having nurses do the mundane work becasue they deserve it after all the hard work they put in. I see AAs saying that they get a better education, though how they come up with that i don't know.

Why are people, who are supposedly well educated and claim to be adults, so monstrously disrespectful of the work others have done or are doing.

What's the deal here? and if i successfully complete a program, am i gonna have to hear that kind of nonsense from people in my professional life?

[jwk]

I should probably listen to my instincts, and stay out of this, but just one comment.

Listen to how the phrase "student nurse anesthetist" sounds. You tend to hear "student nurse--------anesthetist". It leads to the impression that the SRNA is some person off the street, who is at the very beginning of their education, a student nurse.

The change in terminology is an attempt to acknowledge that the SRNA is already a functioning, experienced professional, who ALREADY HAS a licence to practice at one level, and is currently in training to expand that to another level of professional responsibility.

So the profession is evolving. If "resident" ends up not fitting, maybe some other term will appear. But a "hidden agenda" to sound more like medicine??? Come on!!!

loisane crna

I was going to stay out of it past my first post, but the thread took a different direction than the OP.

I don't know - I still think they're students, working on a degree, even though it is an advanced degree. And I don't think in an educational environment that student necessarily gives a negative connotation. In med schools / nursing schools / teaching hospitals, you expect to see students of all types, and in all the facilities I've been involved with, there is an acknowledgement of that on both hospital and OR informed consent forms.

I'll defer on the hidden agenda, but as I stated in my previous post, I haven't seen "resident" used with any other type of advanced nurse practitioner student, so I don't think it's totally an off-the-wall topic to wonder about.

[athomas91]

other nurse practictioner type trainings do not have the clinical nor didactic requirements that SRNA's have. this is not meant as any type of degradement - just that it is comparing apples to oranges - both fruit - but different.

in my program we are referred to as SRNA's - i haven't dedicated much thought to it - as it really doesn't matter in the long run ... i introduce myself as part of the anesthesia team - if they specifically ask - i explain that i am in school finishing my graduate education in anesthesia - that i have been a nurse since 1998 caring for patients. i find that most are very receptive to that idea - i like to further educate them as to who started the anesthesia profession as well as how much anesthesia is actually provided by CRNA's .

on the other hand - calling us students although technically true - is akin to calling residents students... they already have their degree as well but are specializing and/or finishing their training....just like me.

loisane - good post as always,

Andrea

[jewelcutt]

I've tried introducing myself several different ways (mainly just for fun to see which one I like best), whether it be anesthesia student, nurse anesthesia student, part of anesthesia team, or anesthesia intern. I find that if I add the word student without explanation many patients often give you that brief pause and holding of breath (with the slightly green look on the face). So for a while now I have been introducing my self "Hello, I'm a nurse and an anesthesia intern, I'll be with you today during your procedure" It is the absolute truth and I'm not trying to trick anyone. Patients have always trusted me as a nurse and I'll always be a nurse. I don't like this pettiness about titles, why does everyone think we all have secret agendas? My days are long enough, people are always telling me what to do, when to eat, etc, I don't have time to please everyone with their vision of what my title should be. Also, we don't come up with these titles, out programs do. And if patients ask me what I do or for further details, I tell them, I don't secretly say I'm a "doctor", for godsakes! I often respond like athomas does, explaining my background and my pursuit for graduate degree, it's another great opportunity to educate the public about who we are and what we do.

[rn29306]

I was going to stay out of it past my first post, but the thread took a different direction than the OP.

I don't know - I still think they're students, working on a degree, even though it is an advanced degree. And I don't think in an educational environment that student necessarily gives a negative connotation. In med schools / nursing schools / teaching hospitals, you expect to see students of all types, and in all the facilities I've been involved with, there is an acknowledgement of that on both hospital and OR informed consent forms.

I'll defer on the hidden agenda, but as I stated in my previous post, I haven't seen "resident" used with any other type of advanced nurse practitioner student, so I don't think it's totally an off-the-wall topic to wonder about.

jwk, I tried to PM you but your quota for stored mail has been exceeded and cannot accept any more incoming mail. Could you please clear some messages so that mine will go through?

Thanks

rn29306

[Athlein1]

Thank you gentlemen,

Ahhh, feel the love...

[jwk]

jwk, I tried to PM you but your quota for stored mail has been exceeded and cannot accept any more incoming mail. Could you please clear some messages so that mine will go through?

Thanks

rn29306

ok - try again :)

[deepz]

Tenesma, .....your comment re: RRNA's (cute) is offensive to many on this board. .........

At least she didn't ask Alan if he smoking crack!

deepz

And yes, 239, CRNAs do define themselves and their own profession -- and their own terminology. We don't define the A$A and they do not define us. Malign us, yes; define us, no.

[NGACRNA]

I don't know where you got that bad piece of info.

Boards, up unitl recently, were VOLUNTARY for anesthesiologists. And I know a WHOLE lot that either:

a) didn't take them, or

b) failed them

And as for residents getting good cases, I've seen too many lazy residents (of course they are slave labor for nights in some university med centers) duck out of cerebral aneurysm repairs, AAAs, etc.

Where I trained CRNAs and SRNAs did everything involved with the case: awake fiberoptic intubation, a-line, PA-cath, etc etc.

Oh, and did you know that the average anesthesiologist does only one (1) C-section under general anesthesia in their entire "4" year residency?

Add to that the fact that most can't do a simple machine check (because they're never taught). That last one's straight out of the ASA newsletter.

Lastly, SSEPs, and MEPs? Do them all the time.

(refer to yourselves as "Graduate Nurse Anesthetists")

[jwk]

I don't know where you got that bad piece of info.

Boards, up unitl recently, were VOLUNTARY for anesthesiologists. And I know a WHOLE lot that either:

a) didn't take them, or

b) failed them

And as for residents getting good cases, I've seen too many lazy residents (of course they are slave labor for nights in some university med centers) duck out of cerebral aneurysm repairs, AAAs, etc.

Where I trained CRNAs and SRNAs did everything involved with the case: awake fiberoptic intubation, a-line, PA-cath, etc etc.

Oh, and did you know that the average anesthesiologist does only one (1) C-section under general anesthesia in their entire "4" year residency?

Add to that the fact that most can't do a simple machine check (because they're never taught). That last one's straight out of the ASA newsletter.

Lastly, SSEPs, and MEPs? Do them all the time.

(refer to yourselves as "Graduate Nurse Anesthetists")

Interesting - virtually every anesthesiologist I know in the northern part of Georgia (probably >100) are board certified or fairly new out of residency and board eligible. If they are not on that track or already board certified, they won't last long in any of the major anesthesiology groups. Now they may find their way to smaller towns and hospitals, but they're not quite as selective - they can't afford to be, although I will be the first to agree that a bad anesthesiologist is most certainly NOT better than no anesthesiologist.

As for the average anesthesiologist only doing one general C/S during residency? That seems a little far fetched - where did you get your figure?

[mwbeah]

JWK,

You may find this interesting.

Both hospital characteristics and board certification of anesthesiologists affect patient outcomes

Patients undergoing surgery aided by experienced anesthesiologists who are not board certified suffer more deaths or failure to rescue (rate of death after complications) than patients of midcareer board-certified anesthesiologists. However, the poor outcomes associated with noncertified anesthesiologists may be a result of the hospitals at which they practice and not necessarily their manner of practice, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS06560 and HS09469).

The researchers found that noncertified anesthesiologists were more likely than those with board certification to practice at hospitals with fewer characteristics associated with quality care. Such factors include hospital size, nurse-to-bed ratio, percentage of board-certified surgical staff, presence of a trauma center, and others. These hospital factors play an important role in determining patient outcomes, explains Jeffrey H. Silber, M.D., Ph.D., of the University of Pennsylvania School of Medicine.

Dr. Silber and his colleagues analyzed Medicare claims records for nearly 145,000 elderly Pennsylvania patients who underwent general surgical or orthopedic procedures between 1991 and 1994. They compared the outcomes of 8,894 patients who had midcareer anesthesiologists (11-25 years after medical school graduation) who lacked board certification with all other cases.

After adjusting for other factors affecting patient risk of death, the odds of death and failure to rescue were both 13 percent greater when care was delivered by noncertified midcareer anesthesiologists. This corresponded to 3.8 excess deaths and 9.2 excess deaths following complications (failure to rescue) per 1,000 patients. Adjusting for international medical school graduates did not change these results. In addition, hospital characteristics often associated with improved quality were consistently less evident in the noncertified group.

In summary, the researchers note that the current study provides strong evidence that anesthesiologist board certification status is an important factor associated with surgical outcomes, but it must not be used in isolation. They conclude that midcareer anesthesiologists who lack board certification and the hospitals in which they are employed appear to be associated with worse outcomes for surgical patients.

See "Anesthesiologist board certification and patient outcomes," by Dr. Silber, Sean K. Kennedy, M.D., Orit Even-Shoshan, M.S., and others, in the May 2002 Anesthesiology 96(5), pp. 1044-1052.

[mwbeah]

candidate trends: the resident match articles in the asa newsletter by alan w. grogono, m.d., regularly bring the asa membership up to date on anesthesiology residency numerical trends. the smallest ca-1 entering class occurred in 1996 with the subsequent smallest ca-2 class, ca-3 class, aba written examination cohort and aba oral examination cohort following successively in 1997, 1999, 2000 and 2001, respectively. from 1994 to 1998, the overall pass rate on the aba written examination varied from 61 percent-71 percent. in 2000, however, along with the lowest number of candidates, the written examination pass rate sunk to a nadir of 46 percent, climbing back to 55 percent in 2001 and then to 62 percent in 2002. those who passed the written examination experienced similar overall oral examination pass rates to prior years-70 percent-74 percent for the period between 1997 and 2002 with a consistent pass rate between 79 percent-83 percent for the subset of new american medical graduates.

[Kiwi, BSN, RN]

candidate trends: the resident match articles in the asa newsletter by alan w. grogono, m.d., regularly bring the asa membership up to date on anesthesiology residency numerical trends. the smallest ca-1 entering class occurred in 1996 with the subsequent smallest ca-2 class, ca-3 class, aba written examination cohort and aba oral examination cohort following successively in 1997, 1999, 2000 and 2001, respectively. from 1994 to 1998, the overall pass rate on the aba written examination varied from 61 percent-71 percent. in 2000, however, along with the lowest number of candidates, the written examination pass rate sunk to a nadir of 46 percent, climbing back to 55 percent in 2001 and then to 62 percent in 2002. those who passed the written examination experienced similar overall oral examination pass rates to prior years-70 percent-74 percent for the period between 1997 and 2002 with a consistent pass rate between 79 percent-83 percent for the subset of new american medical graduates.

was a new test administered in 2000? that number is down a couple standard deviations.