Are CRNA's trained in big cases?

[urgewrx]

Does anyone know? Do they do hearts, livers, crani's, etc, during CRNA school? It seems to me that mosts CRNA schools are in the middle of nowhere, where a lap chole is a big case. Am I wrong?
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[EtherMD]

Does anyone know? Do they do hearts, livers, crani's, etc, during CRNA school? It seems to me that mosts CRNA schools are in the middle of nowhere, where a lap chole is a big case. Am I wrong?
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Wrong again. Those CRNA's training at a top program get a lot of exposure to big cases including livers, hearts and heads.

 

[SouthSideSteve]

Why do you think most schools are in BFE? The more lucrative job oppurtunities are in BFE, but most CRNA programs are located at schools with med/nursing schools. Phoenix Online doesn't offer a CRNA curriculum to my knowlegde.


I've seen both ends of the spectrum regarding hearts (im a CVICU RN) (and i imagine its largely dependant on MD and hospital preference). Ive worked in hospitals where the MD came in bull****ted with the CRNA for a few minutes then left the room. CRNA did induction/lines, etc. The hospital I'm at now doesn't allow CRNAs to place lines and usually the MD intubates. So the CRNA basically charts and write vitals for the case. The MD pretty much stays in the room and has much more of a role than the previous hospital I worked at. THis experience turned me off to CRNA school as I'd prefer a tad more autonomy. So I will most likely do S.A. or try my hand at med school.


In the first instance the CRNA did only hearts and had done so with the same surgeons for years, he knew his **** and was awesome. In this case they have new grads in the rooms and the CT surgeon pretty much despises CRNAs. Im sure the circumstances had a lot to do with it as well.

 

[urgewrx]

Wrong again. Those CRNA's training at a top program get a lot of exposure to big cases including livers, hearts and heads.

Ether, I'm not talking about top programs. I talking about new programs that are sprouting out of the ground in the dessert.

 

[Monty Python]

Does anyone know? Do they do hearts, livers, crani's, etc, during CRNA school? It seems to me that mosts CRNA schools are in the middle of nowhere, where a lap chole is a big case. Am I wrong?
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I was blessed to train at one of the best trauma hospitals in the US. Busiest knife-and-gun club in the country. Military types including USUHS went there for trauma out-service. Second-biggest hospital in the country by bed licensure. We also had the full gamut of non-trauma services. SRNAs did everything under the sun. We also rotated to Children's Hospital, and my program has since expanded the peds rotation to include St. Jude's (as well as St. Luke's in Houston for more hearts).

Regarding SRNA programs sprouting up everywhere, consider this: about 50% are affiliated with university medical centers and have a solid-to-great foundation of clinical experiences. The other 50% of SRNA programs are affiliated with/owned by private free-standing universities (not medical centers). Their clinical foundation is generally found in community hospitals to a large extent.

 

[BlackScorpion]

So what's the difference in training between anesthesia residents and SRNAs? If there is no significant difference, then I would assume this would legitimize the AANA propaganda of equality between the two providers.

 

[Planktonmd]

So what's the difference in training between anesthesia residents and SRNAs? If there is no significant difference, then I would assume this would legitimize the AANA propaganda of equality between the two providers.

One of them is a doctor and the other is a nurse.
One of them has a real understanding of physiology and pharmacology and can apply that understanding to patient care, the other one can apply memorized concepts sometimes, and look really good and organized thanks to nursing background.

 

[EtherMD]

So what's the difference in training between anesthesia residents and SRNAs? If there is no significant difference, then I would assume this would legitimize the AANA propaganda of equality between the two providers.

Now add in the DNAP which requires 40 months of "residency" training and you begin to see the AANA's real agenda: Equivalence.

The University Programs are "selling out" the profession in a big way. So, if you want to know why Anesthesia will be viewed as "Nursing" in 10-15 years just look around your O.R.'s.

Most likely the AANA will win "Independence" for its members in 15-20 years.
This means MD/DO Anesthesiologists end up as "consultants" to CRNA's and as supervisors to AA's. This means a lot fewer of us will be needed in the hospital or we earn CRNA with DNAP level pay (as a solo provider).

The window to fight back against the AANA its agenda will not be open forever.

 

[johankriek]

Now add in the DNAP which requires 40 months of "residency" training and you begin to see the AANA's real agenda: Equivalence.

The University Programs are "selling out" the profession in a big way. So, if you want to know why Anesthesia will be viewed as "Nursing" in 10-15 years just look around your O.R.'s.

Most likely the AANA will win "Independence" for its members in 15-20 years.
This means MD/DO Anesthesiologists end up as "consultants" to CRNA's and as supervisors to AA's. This means a lot fewer of us will be needed in the hospital or we earn CRNA with DNAP level pay (as a solo provider).

The window to fight back against the AANA its agenda will not be open forever.

why cant the program directors and hospital chairman state in hospital by laws that advanced nurses arent allowed to place central lines of any sort, spinals epidurals or regional blocks.. period..... my hospitals although there are no crnas there are bylaws that state that the only people for example that are allowed to place central lines and the like are physicians.. and they have to prove.. in writing that they are competent. because if you allow for instance a NP to have all the prescription priveleges of a lets say family physician... this blurs the line between physician and technician.. and really does a disservice to everyone who trained to become a physician

 

[BlackScorpion]

So it sounds like CRNAs are trained similarly to residents. If this is the case, then this really is a disservice to the profession. I guess ether is right, future attendings will need fellowships to distinguish themselves from nurses. However, by that time (10-15 years) CRNAs may be competing for fellowships as well.

 

[EtherMD]

So it sounds like CRNAs are trained similarly to residents. If this is the case, then this really is a disservice to the profession. I guess ether is right, future attendings will need fellowships to distinguish themselves from nurses. However, by that time (10-15 years) CRNAs may be competing for fellowships as well.

Time to return to reality. The vast majority of CRNA schools are 27-28 months in duration. In about 7-10 years this will increase to 40 months for the DNAP. Any MD/DO doing a fellowship in the next few years is DECADES ahead of the AANA. Most CRNA's will do the minimum required to get a good job. This is why many of them went into the field. An MD/DO degree, Residency and Fellowship puts you in a different league compared to a CRNA.

Even after 2017 I don't see CRNA's competing at the same level as fellowship trained subspecialist. Yes, they will make inroads with the DNAP but I doubt a significant number will agree to more than 40 months of formal education/training. The CRNA "fellowships" will be a few months in duration and will NEVER make the CRNA a Physician. So, before you leap three decades into the future with conjecture please realize a fellowship will serve a new MD graduate very, very well for a long time.

 

[BlackScorpion]

I was being sarcastic about CRNAs competing for fellowships. If they start now or in the future, then the profession of medicine not just anesthesia will be in trouble.

Back to the topic at hand, to those in the know do CRNA programs have a similar curriculum as residency MD programs?

 

[me454555]

Scorpian,

Another thing you need to realize is that its not only about the lenth of the training that makes an aneshtesiologist, its also about volume of cases, difficulty of cases, and decision making processes. The ASA has very strict guidlines about #s and cases. I'm not sure what it is for the CRNAs but I doubt they are as stringent when it comes to some of the more complicated cases and procedures

 

[core0]

Now add in the DNAP which requires 40 months of "residency" training and you begin to see the AANA's real agenda: Equivalence.

The University Programs are "selling out" the profession in a big way. So, if you want to know why Anesthesia will be viewed as "Nursing" in 10-15 years just look around your O.R.'s.

Most likely the AANA will win "Independence" for its members in 15-20 years.
This means MD/DO Anesthesiologists end up as "consultants" to CRNA's and as supervisors to AA's. This means a lot fewer of us will be needed in the hospital or we earn CRNA with DNAP level pay (as a solo provider).

The window to fight back against the AANA its agenda will not be open forever.

Curious where you got the 40 month "residency". The Not sure exactly what a DNAP is but the DNP (Doctorate of Nursing Practice) calls for 1000 hours above the current APN (advanced practice nurse training). Most CRNA programs seem to be around 27 months. The ones that are transitioning to DNP seem to be around 36 months which would confirm this. Remember this is combined clinical and didactic time not just "residency" by which I presume you mean clinical time.

Here is the ANA position:
http://www.aana.com/uploadedFiles/P...DNP/Addendum B - Presentation Highlights .pdf
Here is the white paper which mentions the practice title:
http://www.aacn.nche.edu/DNP/pdf/DNP.pdf
Here is the NONPF statement:
http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/CompetencyDraftFInalApril2006.pdf

Just in case you doubt the true intention of the DNP here is one statement:
"Competency Area: Independent Practice
(1) Practices independently by assessing, diagnosing, treating, and managing undifferentiated patients
(2) Assumes full accountability for actions as a licensed independent practitioner"

David Carpenter, PA-C

 

[Unconscious]

Anesthesia chairs that allow CRNA/SRNA's to do complex cases are doing us a disservice, I know they need some training in difficult cases but that gives a budding SRNA a wrong attitude, same attitude that make some of them think that they can do it all. Don't missunderstand me, I think many CRNAs are very capable, I'm learned a lot of technical skills from CRNAs, but As a Resident, you see SRNA assigned to a crainy and a resident to a CTS release over and over, it makes you wander what Chairs/PDs doing about it. Another important factor is surgeon's attitude, many of them rather have a CRNA that they can boss around then an MD/DO that stand their grounds and run the show. The ACS have a vague stance re. anesthesia providers (on their website, they do not have a statement regarding the issue, under search you may find a statement by Chicago ACS chapter:http://www.facs.org/chapters/mccacs/legislative/rules.html
I think the ACS needs to take a stance and work with the ASA regarding regulation of CRNAs working under surgeons licence.

 

[EtherMD]

Curious where you got the 40 month "residency". The Not sure exactly what a DNAP is but the DNP (Doctorate of Nursing Practice) calls for 1000 hours above the current APN (advanced practice nurse training). Most CRNA programs seem to be around 27 months. The ones that are transitioning to DNP seem to be around 36 months which would confirm this. Remember this is combined clinical and didactic time not just "residency" by which I presume you mean clinical time.

Here is the ANA position:
http://www.aana.com/uploadedFiles/P...DNP/Addendum B - Presentation Highlights .pdf
Here is the white paper which mentions the practice title:
http://www.aacn.nche.edu/DNP/pdf/DNP.pdf
Here is the NONPF statement:
http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/CompetencyDraftFInalApril2006.pdf

Just in case you doubt the true intention of the DNP here is one statement:
"Competency Area: Independent Practice
(1) Practices independently by assessing, diagnosing, treating, and managing undifferentiated patients
(2) Assumes full accountability for actions as a licensed independent practitioner"

David Carpenter, PA-C

David,

Thank You for the clarification. 36 months sounds like a good deal for the DNAP. We will know the actual time when MCV graduates its first class but I bet you are correct. NO doubt about the goal for full, Independent practice in every State.