Why havent CRNAs pushed MDAs out yet?

[platon20]

OK, guys correct me if I'm wrong, but:

1) No state in the country requires MDA supervision

2) CRNAs work independently in all 50 states

So, if this is true, why are so many hospitals still using a combined MDA/CRNA staff? This doesnt make any sense to me at all. MDAs dont do anything on top of what the CRNA does. The 2 job descriptions are EXACTLY IDENTICAL, yet MDAs make at least twice as much money as CRNAs.

Why would hospitals continue to hire MDAs, unless there are no CRNAs available to hire? This just doesnt make any sense to me at all. You can hire 3 CRNAs for the price of 1 MDA, and you would not see a difference at all in terms of patient outcomes.

[skipaway]

Nice assumption but wrong.

I think maybe your Profile which states that you are a student nurse may be where Mike made his assumption. Congrats if you've graduated. I agree that not all viewpoints should be the same, but as other's have so elegantly stated, we have been fighting the same battles for years.

[TheLemur]

first i would like to start off with the statement that i usually try to stay out of these arguments as they tend to go nowhere. however, this time i'll jump in and give my 2 cents.

i am a crna and work in an institution that trains both SRNA's and residents.

some of my training was also in this type of setting and i have seen how both are done.

to make the statement that physicians are better trained or have more experience because they are md's and go through residency programs that offer many different experieces is just not accurate. are they trained more in medicine, sure, in mediciine. nursing has it's own advantages when it comes to anesthesia that medicine does not have. i'll use the icu as an example as that is where my nursing experience comes from. while the resident sees the patient and writes orders on the care of the patient. i am the practicioner that delivers that care, i sit at the bedside for 12 hours titrating gtts, pushing med, manageing fluids etc. and documents and observes the effects on the patient and adjusting the plan within parameters. so delivery, observation and titration of all sorts of agents, i think, gives the nurse the advantage when assessing changes in the patients dynamics while under anesthesia as this is what we do at the bedside. this is what i'll call vigilence.

residents will get to manage, through the nurses for delivery, the care of pts with htn, pe's diabetes etc. but the management of these under anesthesia is different than trying to optimize the patient for daily living. any emergency in the OR can be treated equally well by any well trained anesthesia provider. the key is knowing what drugs to use when, in some cases, which is why we take pharmacology. other times it's just abc's and supportive actions at other times. neither of which require a residency rotation in ER, ICU, Internal medicine etc etc. airway management that was mentioned earlier is a skill that a monkey can be taught, thats why as CRNA's in training, youre paired with a CRNA to teach you these skills, i now residents and attendings that couldnt start an iv if their life was on the line. so that argument holds no water.

also it has been stated on the board more than once that anesth. residents have better training in anesthesia. that is just plain bogus. i have no randomized control trial study to back this up, its anectdotal at best, but i have witnessed 3 residency training programs, which for reasons known i can't state who they are, put first year, first week residents in a case, when the only anesthesthesia training they had was when they were given a copy of morgan and makhail a day earlier and were told to read the first 3 chapters, and were left alone with the patients, to manage the case. i have actually had residents, just a couple mind you, whom i was paired with as a senior student state they felt they had no idea what they were doing and that we were much more prepared to be in the OR initially. this was after several discussions on patient management during the case.

medical anesthesia and nurse anesthesia get to the same destination but often get there by different routes. i can tell, with about 95% certainty, after observing an anesthesia provider for about 15 minutes if they are a doc or a nurse. most seasoned providers will tell you the same thing.

i dont dislike residents, or attendings, and i think there is enough pie to go around also, however i dont like mda's trying to dictate NURSE anesthesia, and the parameters or levels at whick we can practice. nurses do not interfere with the practice or medicine, medicine should stay out of the state boards of nursing and nursing practice. we all have the best interests of the patients in mind. we both put out well trained providers, with a very few exceptions.

anesthesia politics revolves mostly around money, to believe otherwise is a mistake. the root of most political smoke, is the result of buring money.

there is alot more i could go on about, but i'll stop here for now.

d

Good post.

Still, this thread is a real loser that barely deserved such a well-written and thought out statement. What are the OP's intentions, anyway?

I have heard a veteran CRNA, former prez of the AANA, probably as "militant" as they come, say that we need the doc's, and they need us. If that's how she feels, then it's good enough for me.

At no point, as far as I can tell, has it been the goal of organized nurse anesthetists to push MD's out of the practice of anesthesia. A more accurate description is that nurse anesthetists have fought to prevent THEM from pushing US out of practice.

It's a real bummer to me that there is such political animosity between the two professions. Political maneuvering by the AANA to block resident training (or the reimbursement thereof, or whatever) is not going to help it either. It's too bad that the mistrust goes that deep that the AANA feels it necessary to use such tactics, but I don't know the whole story. The cycle continues.

It has been a relief to see CRNA and anesthesiologists working together so well at my clinical site. If there is tension there, it's not out in the open. When it comes down to it, final decision rests with the MD. Got a problem with that? Don't work in an ACT. But I've found that the attending's judgement is overwhelmingly reasoned and informed by experience and literature that exceeds most of the CRNA's. And if not, the CRNA's are in position to question it without hesitation.

One may get the impression on these forums that the professions will never get along. Maybe they won't; certainly not when financial interests trump fairness. But from what I can tell, this BS is peripheral to good patient care, which comes from doctors AND nurses, and especially when working together.

[MmacFN]

Skip

Yup thats where i got it.

Topher.

The difference between a seasoned RN in application process to NA school posting on this forum and a supposed student posting on an advanced practice forum is signifigant.

About the thread

Well, this will be an unpopular view but here goes. I like these threads. Not so much the start of the thread but the end here. I enjoy reading what CRNAs (new and old) write in response to these issues. If threads like this stopped occuring it may well keep the issues "out of sight out of mind" to all new new people.

As an example. My experience with CRNAs and MDAs is limited to my time in the OR for intubations and PACU. From that limited perspective I would assume exactly two things:

1) CRNAs and MDAs have a great working relationship without political issues.

2) MDAs are in a supervisory role similar to the ER doc and the ER RN.

Neither of these two assumptions are true and ive learned that, directly and indirectly (watchful care), from here. I thank everyone for the responses.

One of the truths of politics is that in order to get what you want you have to keep it in the public eye as long as possible.

Thanks for all the throughtful responses which have added to my understanding of the issues. I think i have, somewhat, a handle on the general themes.

I think maybe your Profile which states that you are a student nurse may be where Mike made his assumption. Congrats if you've graduated. I agree that not all viewpoints should be the same, but as other's have so elegantly stated, we have been fighting the same battles for years.

[rayman]

On giants' shoulders.

"A dwarf sees farther than the giant when he has the giant's shoulders to mount on."--Samuel Taylor Coleridge: The Friend, sect. i. essay viii.

And yeah, where is yoga????

Sorry for the misquote... Do I at least get credit for remembering you posted it a while back?

Nice quote.

[BeatOU]

Well, this will be an unpopular view but here goes. I like these threads. Not so much the start of the thread but the end here. I enjoy reading what CRNAs (new and old) write in response to these issues. If threads like this stopped occuring it may well keep the issues "out of sight out of mind" to all new new people.

As an example. My experience with CRNAs and MDAs is limited to my time in the OR for intubations and PACU. From that limited perspective I would assume exactly two things:

1) CRNAs and MDAs have a great working relationship without political issues.

2) MDAs are in a supervisory role similar to the ER doc and the ER RN.

Neither of these two assumptions are true and ive learned that, directly and indirectly (watchful care), from here. I thank everyone for the responses.

One of the truths of politics is that in order to get what you want you have to keep it in the public eye as long as possible.

Thanks for all the throughtful responses which have added to my understanding of the issues. I think i have, somewhat, a handle on the general themes.

I agree totally, great posts. I hang in the Pre-CRNA forum because I am overwhelmingly inexperienced in the profession, but

these posts are good, even if they are rehashing of the same arguments. I'm about half way through watchful care and suggest it to anyone who wonders about politics of the profession.

And yea, there is definitely some baiting going on, but it's good practice for a time when we may need to defend the practice somewhere other than the internet, and CRNA baiting by RN's is unique in that it seems to me to smote of jealosy and is sad.