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?

[loisane]

Loisane,

Your statement that "The 'ologists don't really see us as different from other non-specialized nurses, while CRNAs perceive the difference to be quite significant," drives home a point that I really was not aware of. I just assumed that anesthesologists did see us different from other non-specialized nurses. Trauma Tom

TTom, your post reminds me that I should make it clear that I am speculating this to be true. I don't have the data (yet). I am very sure I have encountered this attitude among some individuals. But there may be other individuals with very different attitudes.

I believe the root source of all this "politics" that started this thread, is the difference in definition of the ACT. Organized anesthesiology recognizes no role for autonomous CRNAs. All CRNA delivered anesthesia must involve an anesthesiologist. While some anesthesiologists may feel differently (as deepz and others have described) as long as this is on record as the position of the profession, it is going to affect our interactions with them.

loisane crna

[Tenesma]

i don't know if i can speak for all physicians, but CRNAs are not considered equal to other non-specialized nurses.... they are considered to be superior to non-specialized nurses (extra education, etc...) However many physicians i know (especially non-anesthesiologists), consider CRNAs to be equal to other specialized nurses: ie: NPs.

[alansmith52]

I just noticed how well my apex compared to base ventilation bate and catch worked.

the simple mind thinks of the V/Q ration right away?

now if i could just teach one of my attendings about how ventilation favors the more distensible base. (or more dependant lung)

lol tee heee

[alansmith52]

I just noticed how well my apex compared to base ventilation bate and catch worked.

the simple mind thinks of the V/Q ration right away?

now if i could just teach one of my attendings about how ventilation favors the more distensible base. (or more dependant lung)

lol tee heee

[TennRN2004]

i don't know if i can speak for all physicians, but CRNAs are not considered equal to other non-specialized nurses.... they are considered to be superior to non-specialized nurses (extra education, etc...) However many physicians i know (especially non-anesthesiologists), consider CRNAs to be equal to other specialized nurses: ie: NPs.

I am glad to hear physicians recognize the advanced role of nursing. Those who consider FNPs/CRNAs/CNS all equal as advanced nurses are not wrong in that each of these are advanced practicing nurses with more education and a broader clinical responsibility in their field. However, they are not the same, just as a pulmonologist and neurologist are the not the same. Both of these physicians may specialize, but they have different focus of what they do, just as the advance practice nurses can choose to specialize.

Regarding Loisane's comments, I found that perspective enlightening for what goes on in the profession of anesthesia. There defninitely is a lag of communication in regards to collaboration. In the ICU setting, I can tell you, what you describe makes perfect sense. The approach to care is multidisciplinary, but the physicians still want to be head of the team.

In regards to anesthesia however, I think there is another root problem other than the different definitions of collaboration. It has been discussed here before as well. The huge problem I see is how do we define anesthesia? Is is medicine, is it nursing, or can it be BOTH? The problem many anesthesiologists have with CRNAs (being autonomous) is that they see them wanting to practice medicine without obtaining a medical degree. I agree that Loisane's comments about physicians thinking every patient deserves a physician and the patient is a physician's responsibility are right on target. While this goes a long way to explain why there are problems between the nurse/doctor relationship, it also points out doctors have a lot of power/control and will not willingly give this power up, if only for the reason that it is their responsibility to be in control.

I think both sides have alot of compromise before there will be any resolution. However, the profession of medicine cannot place boundaries on the profession of nursing and not expect a cry of injustice. Tenesma, I do not say any of this as offensive to you, or any other anesthesiologist, but honestly, when looking at studies showing safety of supervise/unsupervised nurse anesthetist roles, can you say that the ASA is not biased and would not be capable of leading outcomes in favor of CRNAs needing supervision?

I know there are some CRNAs out there who should flat not be practicing independently, but that coin can also flip to include anesthesiologists who are not safe practioners. This post has definitely taken on a political/activism tone as Loisane did not intend hers to be, but I consider this the reason why there will be struggle in anesthsia.

When CRNAs view themselves as top notch practioners, and the highest acheivement in their profession, it is a slap in the face to be reminded over and over they are considered inferior to 'ologists, whether this inferiority is warranted or not. The oppinions are many anesthesiologists are warped by the ASA stance on keeping anesthesia a medical turf only.

[TennRN2004]

i don't know if i can speak for all physicians, but CRNAs are not considered equal to other non-specialized nurses.... they are considered to be superior to non-specialized nurses (extra education, etc...) However many physicians i know (especially non-anesthesiologists), consider CRNAs to be equal to other specialized nurses: ie: NPs.

I am glad to hear physicians recognize the advanced role of nursing. Those who consider FNPs/CRNAs/CNS all equal as advanced nurses are not wrong in that each of these are advanced practicing nurses with more education and a broader clinical responsibility in their field. However, they are not the same, just as a pulmonologist and neurologist are the not the same. Both of these physicians may specialize, but they have different focus of what they do, just as the advance practice nurses can choose to specialize.

Regarding Loisane's comments, I found that perspective enlightening for what goes on in the profession of anesthesia. There defninitely is a lag of communication in regards to collaboration. In the ICU setting, I can tell you, what you describe makes perfect sense. The approach to care is multidisciplinary, but the physicians still want to be head of the team.

In regards to anesthesia however, I think there is another root problem other than the different definitions of collaboration. It has been discussed here before as well. The huge problem I see is how do we define anesthesia? Is is medicine, is it nursing, or can it be BOTH? The problem many anesthesiologists have with CRNAs (being autonomous) is that they see them wanting to practice medicine without obtaining a medical degree. I agree that Loisane's comments about physicians thinking every patient deserves a physician and the patient is a physician's responsibility are right on target. While this goes a long way to explain why there are problems between the nurse/doctor relationship, it also points out doctors have a lot of power/control and will not willingly give this power up, if only for the reason that it is their responsibility to be in control.

I think both sides have alot of compromise before there will be any resolution. However, the profession of medicine cannot place boundaries on the profession of nursing and not expect a cry of injustice. Tenesma, I do not say any of this as offensive to you, or any other anesthesiologist, but honestly, when looking at studies showing safety of supervise/unsupervised nurse anesthetist roles, can you say that the ASA is not biased and would not be capable of leading outcomes in favor of CRNAs needing supervision?

I know there are some CRNAs out there who should flat not be practicing independently, but that coin can also flip to include anesthesiologists who are not safe practioners. This post has definitely taken on a political/activism tone as Loisane did not intend hers to be, but I consider this the reason why there will be struggle in anesthsia.

When CRNAs view themselves as top notch practioners, and the highest acheivement in their profession, it is a slap in the face to be reminded over and over they are considered inferior to 'ologists, whether this inferiority is warranted or not. The oppinions are many anesthesiologists are warped by the ASA stance on keeping anesthesia a medical turf only.

[BigDave]

Just my two cents...as a nurse practitioner and a CNS--the amount of dedication, commitment to the profession and absolute dead on "have to do the right thing every time" places CRNAs at a much higher level of practice than other advanced practice nurses. There is a widely regarded saying in medicine that 1/2 of the patients will get well regardless of the MD/NP/whoever intervention is made. Do us in this forum consider the same in the OR?

As far as education goes, I worked two days/week in a cardiac surg ICU, restored a 67 Mustang, we had a new baby, I took extra classes for a dual-degree...and still got a 4.0. Any of you SRNAs feeling any of that freedom?

[air]

One thing is certain, Alansmith is pro-nursing.

Alan, should you care to run for office at any of our professional organization, you have my vote.

I do not necessarily agree with all that you espouse but you write with convicted passion and you stick with it, in the end that's all that matters.

[Brenna's Dad]

All very interesting stuff.

Regarding my very early comment regarding the mechanical aspects of anesthesia.... I was not necessarily referring to advanced clincal skills such as the insertion of lines, nerve blocks, etc., but rather the more mundane aspects such as titration of medications, mixing of drugs for infusions, IV catheter placement, vigalence, etc.

The residents I have observed are trained to assess patients and give orders for nurses to follow. I havent seen any physicians mixing and titrating drugs for example or spending long hours at the bedside observing patient trends. This is what I believe must be the hard work for physicians when learning aneshesia (and please correct me if im wrong). This is where critical care nurses have the benefit when learning anesthesia. Physicians have the benefit of a thourough medical education of course.

[deepz]

......The residents I have observed are trained to assess patients and give orders for nurses to follow. .... must be the hard work for physicians when learning aneshesia ......

Yes, BD, as noted previously on other threads, most residents spend the first two years attempting to learn how to act like a nurse and actually DO hands-on patient care. Many just don't get it. Some consider it beneath their dignity.

Therefore, CRNAs will never lack for demand for their services.

deepz

[athomas91]

had to post this...sorry....:)

an MDA i worked with recently (who is great and full of knowledge and a benefit to my learning) didn't know how to set up the fluid/blood warmer.... he was very open about it - i don't do that - how do you do that....so now it is a joke - when he asks me something i don't know i first tell him i will look it up and get right back to him - then i ask him how to set up a fluid warmer. heheheheh