colorado opt out

[yasawa]

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I find it interesting that so many nurses are fighting for autonomy and equivalence but when it comes down to their own care, they want MD's. Since starting CA-1 year, I've had two nurses and one nurse's son as patients. Two of the nurses were very specific and demanding about all aspects of their care. They demanded specific preop floors and PACU floors since they had friends on those floors but refused to allow a CRNA to do their anesthesia. The mother( who is an NP/OR nurse manager) refused to allow anyone but an MD to see her 22yr old son. She even refused to allow the NP at the preop IM clinic to see him. At first she wanted an attending only room for both surgery and anesthesia but after both departments told her it wasnt possible she agreed to allow residents in the room but refused to have any surgical PAs or CRNAs. At the end of the day, when it comes down to their own health or the health of a loved one, nurses/midlevels want nothing but the best.

 

[Matty44]

Maybe this is a stupid question, but if CRNAs can already work under the supervision of a surgeon (with no anesthesiologist present), why do they even care if they can opt out? It seems like if the only requirement is that a physician needs to be present, and a surgeon fulfills that role, then they can legally practice anywhere without an anesthesiologist, right? So why are they even pushing for opt out? Does the surgeon take a percentage of billing for anesthesia services provided as he/she is providing "medical direction/supervision" and therefore CRNAs income would be increased by opting out? What is the real reason behind them wanting to opt out? I'm sure I could look this up myself somewhere, but Im' being lazy 😴

 

[BLADEMDA]

Maybe this is a stupid question, but if CRNAs can already work under the supervision of a surgeon (with no anesthesiologist present), why do they even care if they can opt out? It seems like if the only requirement is that a physician needs to be present, and a surgeon fulfills that role, then they can legally practice anywhere without an anesthesiologist, right? So why are they even pushing for opt out? Does the surgeon take a percentage of billing for anesthesia services provided as he/she is providing "medical direction/supervision" and therefore CRNAs income would be increased by opting out? What is the real reason behind them wanting to opt out? I'm sure I could look this up myself somewhere, but Im' being lazy 😴

Legitimacy. CRNAs aren't a legitimate Solo provider in the eyes of many surgeons. Hence, by making surgeons "sign off" of billing or any other paperwork only reinforces the concept that CRNAS are working under the direction of the surgeon.

Opt-Out gives the illusion (AANA calls it reality) that the CRNA is functioning Independently. The surgeon doesn't need to sign anything.

 

[Matty44]

So there's no change in pay or responsibility, its just an ego thing? If that's the case, are there really no practical changes once a state opts out?

 

[BLADEMDA]

So there's no change in pay or responsibility, its just an ego thing? If that's the case, are there really no practical changes once a state opts out?

This is a 100 year war. Victories are measured in inches/cm and not meters. Each small victory by the AANA legitimizes Solo CRNA in some small measure.
These Opt-Outs must be opposed and are a serious threat to the specialty.

 

[ProRealDoc]

👍 Correct. This conflict has been going on since before I started residency more than 20 years ago. It will be going on long after I am done. I suggest that all those at the beginning of their careers accept that.

Totally passive attitude that does nothing to change to status quo. 👎. No wonder we are where we are.

 

[pgg]

How about a study showing that hospitals in OptOut states continue to have physician supervision of nurse anesthestists the vast majority of the time therefore the nurses study is total BS?

It isn't just "supervision" ... frequently we'll just end up doing the cases for them.

When I'm the #2 call person behind a #1 call "independent" CRNA in this opt-out state, I still get called to the hospital to

• place lines
• do blocks
• do anything that starts or ends in the ICU
• do cases when the surgeon requests "MD anesthesia"
• do cases when the patient requests a doctor
• help out when the SHTF and the CRNA's eyes get all deer-headlighty

I know a handful of solid CRNAs who can do their own blocks and lines but most are not remotely capable of independently and safely practicing the full spectrum of anesthesia

Funny how this reality isn't ever apparent in the studies purchased by the AANA.

 

[countingdays]

It isn't just "supervision" ... frequently we'll just end up doing the cases for them.




When I'm the #2 call person behind a #1 call "independent" CRNA in this opt-out state, I still get called to the hospital to

• place lines
• do blocks
• do anything that starts or ends in the ICU
• do cases when the surgeon requests "MD anesthesia"
• do cases when the patient requests a doctor
• help out when the SHTF and the CRNA's eyes get all deer-headlighty

I know a handful of solid CRNAs who can do their own blocks and lines but most are not remotely capable of independently and safely practicing the full spectrum of anesthesia

Funny how this reality isn't ever apparent in the studies purchased by the AANA.

I wasn't implying that your supervision wasn't very active.

My point was that to a reporter or aana propagandist, opt-out implies that nurses are practicing independently throughout the state. They are comparing outcomes in opt-out STATES not in the actual LOCATIONS where independent nurse practice actually takes place. In reality, most nurses are practicing under physician supervision even in opt-out states. This needs to be stressed to reporters publishing nursing propaganda. Their 'studies' are totally meaningless.

 

[foxtrot]

Does anyone know if there has been any backlash against the solo CRNA practice by the public in Colorado? My spouse has several friends who live in Colorado and really knew very little about medicine or anesthesia until this was brought up in the media there. Neither had any idea what a CRNA was, especially since most of them introduce themselves as "your anesthesia provider." Both of them said that if they have to go in for surgery they are going to ask if there are anesthesiologists available. If not, both said they would demand one be present or go elsewhere for elective procedures. I am wondering if those hospitals who are allowing CRNA's to practice independently are noticing that patients have become more educated on the issue.