CRNA autonomy?

[marcus_aurelius]

Is it true that CRNA's can practice without anesthesiologist supervision is something like 16 states?

if this has already happened how soon before all 50 states?

it seems to me that as their training programs get better and better, they will have the knowledge to practice solo.

if they are doing a good job and managed care etc. continue to face pressure to lower operating costs...who is to say that in 10 years anesthesiologists and CRNA's will be equals and earn the same salary (in other words, anesthesiologists would be making A LOT LESS).

any insight?

---

Members don't see this ad.

 

[militarymd]

Is it true that CRNA's can practice without anesthesiologist supervision is something like 16 states?

if this has already happened how soon before all 50 states?

it seems to me that as their training programs get better and better, they will have the knowledge to practice solo.

if they are doing a good job and managed care etc. continue to face pressure to lower operating costs...who is to say that in 10 years anesthesiologists and CRNA's will be equals and earn the same salary (in other words, anesthesiologists would be making A LOT LESS).

any insight?

They can practice independently already in all 50 states. The 16 states is just the Medicare rules.

 

[nitecap]

Sure there are plenty threads within the last what month that could answer your question, do a search man.

 

[Doc13]

Can we please just end this thread now, before it even starts!!

 

[toughlife]

Is it true that CRNA's can practice without anesthesiologist supervision is something like 16 states?

if this has already happened how soon before all 50 states?

it seems to me that as their training programs get better and better, they will have the knowledge to practice solo.

if they are doing a good job and managed care etc. continue to face pressure to lower operating costs...who is to say that in 10 years anesthesiologists and CRNA's will be equals and earn the same salary (in other words, anesthesiologists would be making A LOT LESS).

any insight?

that's the reason you want to go into it because you like it not because of the $$. That can change anytime.

 

[hoop_jumper]

Alimony $5000/month



Child Support $3000/month



Health Insurance for the Family $1000/month



Making more than your MDA "supervisor", Banging his ex-wife, and living it up in his former crib. PRICELESS!!!

 

[miamidc]

So here is the deal. As soon as the public realizes that they might be anesthetized by nurses, that will all change, and believe me people are begining to become aware of this. Soon everyone going into surgery is going to ask to have Dr. instead of nurse Betty making sure they keep em alive. So in essence all we have to do is have mass advertising to make people aware of this, and believe me hospitals will be begging to give MDAs loot so that they can keep their surgical services available and running smoothly. I hate CRNAs, I wish their were more AAs out there. Bottom line we have to fight for out profession and we have to lobby, but we will always be physicians and they will always be nurses, bottom line. And joe shmoe knows the differeance. Peace

 

[sabre518]

So here is the deal. As soon as the public realizes that they might be anesthetized by nurses, that will all change, and believe me people are begining to become aware of this. Soon everyone going into surgery is going to ask to have Dr. instead of nurse Betty making sure they keep em alive. So in essence all we have to do is have mass advertising to make people aware of this, and believe me hospitals will be begging to give MDAs loot so that they can keep their surgical services available and running smoothly. I hate CRNAs, I wish their were more AAs out there. Bottom line we have to fight for out profession and we have to lobby, but we will always be physicians and they will always be nurses, bottom line. And joe shmoe knows the differeance. Peace

man, just let it go... anger issues. i think all anesthesiologists and future anesthesiologists in this forum have made their opinions clear on this issue. if you want to incite a war from the crna/srna's that visit this forum just start a thread that uses the word crna in it.... oh wait, someone just did!

 

[InGasWeTrust]

yawn

 

[marcus_aurelius]

They can practice independently already in all 50 states. The 16 states is just the Medicare rules.

so why arent anesthesiologists worried? are there certain procedures that crna's cant do? do they have the training to bring a patient back to baseline if the s*** hits the fan?

i have no problem with crna's as long as they are earning much less and are not going to compete with us for jobs. if they are adequately trained, i think economically speaking, they should get the jobs bc it saves the medical system money. but if this is the case, i'd rather not choose anesthesia bc i didnt go to med school to be competing with nurses for jobs (no offense).

and yes, money and lifestyle is one of the reasons i am considering gas. i dont think there's anything wrong with that....i think crna's get certified for the same reasons....money and lifestyle.

 

[nitecap]

I have never once heard of an anesthesiologist loosing their job to a CRNA so I dont think there is much to worry about on that note. More anesthesiologist profit from CRNA's if anything. This same crap has been fought about for decades now and really not all that much has changed. All are still practicing, all are still making good money and all are still in high demand.

 

[ecCA1]

Why aren't MDs worried about the CRNA "threat"? Probably because it's got little bite to the bark. The chance of them actually being allowed to act completely independently of a physician is pretty low. Hence, the lack of concern when this issue is brought up by those "MDAs" who bother to read the threads at all.

 

[hoop_jumper]

CRNA reimbursement is exactly the same for MDA's and any CRNA who is charging less for the same level of care/procedure is a fool. There will always be a need for Anesthesiologists but I believe it will be more of a supervisory roll in either Anesthesia or Critical Care as in ICU management. Can CRNA's actually handle it when the **** hit's the fan absolutely (there are always exceptions). Every CRNA has to have a critical care background the average 3-5 or more before entering CRNA programs and many myself included have EMS backgrounds as well critical care nursing. Every program I know of has atleast 6-8 or more applicants for every single slot and unlike a lot of medical schools Affirmitive Action and other support systems do not exist. As far as income a CRNA in a rural setting should easily be paid $200,000 a year.

 

[Monty Python]

Is it true that CRNA's can practice without anesthesiologist supervision is something like 16 states?

if this has already happened how soon before all 50 states?

it seems to me that as their training programs get better and better, they will have the knowledge to practice solo.

if they are doing a good job and managed care etc. continue to face pressure to lower operating costs...who is to say that in 10 years anesthesiologists and CRNA's will be equals and earn the same salary (in other words, anesthesiologists would be making A LOT LESS).

any insight?

No state specifically requires an anesthesiologist to supervise a CRNA.

In 1/2 of the states, CRNA have totally independent and autonomous scope of practice by law.

In the other 1/2 of the states, supervision is required by a "physician or dentist," usually due to technicalities in the Board of Pharmacy regulations over narcotic access.

Local hospital by-laws can always be more restrictive than state law.

There are other fine print aspects when Medicare reimbursement is involved.

 

[Frank Rizzo]

Vent, just close this now.

 

[stephend7799]

the anesthesiologists on this forum have little to worry about

I work with crnas on a dalily basis..

and they are poor clinicians..

Even the best one.. I shake my head at some of the things he does

constantly.. to the point where im asking myself.. How the f.... can they ask for independence while they practice this way?

Seriously they need supervision. The more dangerous thing is that they think they are good. ANd I ( for political reasons) cannot say listen you are doing this all wrong.. They dont accept direction at all.. So they will stay bad...

And the public is buying this ****.. its unbelievable.

 

[Cap'nOblivious]

stephen: can you give some examples of what the "best" crna you work with does that you consider poor clinical judgement?

 

[toughlife]

CRNA reimbursement is exactly the same for MDA's and any CRNA who is charging less for the same level of care/procedure is a fool. There will always be a need for Anesthesiologists but I believe it will be more of a supervisory roll in either Anesthesia or Critical Care as in ICU management. Can CRNA's actually handle it when the **** hit's the fan absolutely (there are always exceptions). Every CRNA has to have a critical care background the average 3-5 or more before entering CRNA programs and many myself included have EMS backgrounds as well critical care nursing. Every program I know of has atleast 6-8 or more applicants for every single slot and unlike a lot of medical schools Affirmitive Action and other support systems do not exist. As far as income a CRNA in a rural setting should easily be paid $200,000 a year.

I agree with the comment in bold.

 

[toughlife]

the anesthesiologists on this forum have little to worry about

I work with crnas on a dalily basis..

and they are poor clinicians..

Even the best one.. I shake my head at some of the things he does

constantly.. to the point where im asking myself.. How the f.... can they ask for independence while they practice this way?

Seriously they need supervision. The more dangerous thing is that they think they are good. ANd I ( for political reasons) cannot say listen you are doing this all wrong.. They dont accept direction at all.. So they will stay bad...

And the public is buying this ****.. its unbelievable.

I doubt they are even considered clinicians. I think to call yourself a clinician you must go to medical school.

The public is ignorant and easily swayed by anything. It is our job to make sure they are aware who is delivering their anesthetic. How about some TV commercials?

 

[ecCA1]

"Every CRNA has to have a critical care background the average 3-5 or more before entering CRNA programs and many myself included have EMS backgrounds as well critical care nursing."

Are we to understand that your critical care background, which consisted of several years of NURSING is supposed to prepare you to handle the sickest patients under the worst conditions?

Is the fact that you were an EMS person meant to somehow bolster your argument?

Your motives here are transparent and your ability to argue is quite limited indeed. Perhaps you'd be better off with a new screen name and attempting to post again, this time with more self-restraint so as to avoid embarrassing yourself again.

 

[stephend7799]

I doubt they are even considered clinicians. I think to call yourself a clinician you must go to medical school.

The public is ignorant and easily swayed by anything. It is our job to make sure they are aware who is delivering their anesthetic. How about some TV commercials?

I think there should be informed consent that specifically states there will be no physician involvement in your anesthetic in the areas where crnas practice independently.. that way patients are informed as to the level of education of the individual who is in charge of their well being while anesthetized..

 

[hoop_jumper]

"Every CRNA has to have a critical care background the average 3-5 or more before entering CRNA programs and many myself included have EMS backgrounds as well critical care nursing."

[Are we to understand that your critical care background, which consisted of several years of NURSING is supposed to prepare you to handle the sickest patients under the worst conditions? ]

Uhhm yeah those are the patients that are in intensive care units.

 

[hoop_jumper]

I think there should be informed consent that specifically states there will be no physician involvement in your anesthetic in the areas where crnas practice independently.. that way patients are informed as to the level of education of the individual who is in charge of their well being while anesthetized..

I think only board certified providers should be giving anesthesia. Ooops that negates about 40% of MDA's and then we could eliminate another 25% if we didn't allow the ones who got into school through affirmative action to deliver anesthesia.

 

[nitecap]

I think there should be informed consent that specifically states there will be no physician involvement in your anesthetic in the areas where crnas practice independently.. that way patients are informed as to the level of education of the individual who is in charge of their well being while anesthetized..

For one thing man in the areas where there is no MD involvement in their anesthetic the pt's dont have much of a choice. Its the CRNA or another hospital that may be a considerable distance away.

 

[ecCA1]

"Uhhm yeah those are the patients that are in intensive care units."

...Where the NURSING STAFF (that's you) take orders from US, the "MDAs." Managing a patient is not what you do; executing orders we give while managing a patient is your job.

As I said, your thickheadedness is both profound and amusing. Think about my advice re: another screen name.

 

[toughlife]

"Every CRNA has to have a critical care background the average 3-5 or more before entering CRNA programs and many myself included have EMS backgrounds as well critical care nursing."

[Are we to understand that your critical care background, which consisted of several years of NURSING is supposed to prepare you to handle the sickest patients under the worst conditions? ]

Uhhm yeah those are the patients that are in intensive care units.

You mean taking care of that ONE patient critical care nurses follow per day?

WOW, that's what I call impressive.

 

[toughlife]

I think only board certified providers should be giving anesthesia. Ooops that negates about 40% of MDA's and then we could eliminate another 25% if we didn't allow the ones who got into school through affirmative action to deliver anesthesia.

and you understand that requiring everyone to be board certified by the ABA would immediately put all CRNA's out of commission, since to be ABA certified means you have to be a physician first.

I am for it.

 

[nitecap]

"Uhhm yeah those are the patients that are in intensive care units."

...Where the NURSING STAFF (that's you) take orders from US, the "MDAs." Managing a patient is not what you do; executing orders we give while managing a patient is your job.

As I said, your thickheadedness is both profound and amusing. Think about my advice re: another screen name.

SO quick question. Pt has crapped out after a CAB and on mega drips that the MD ordered. However Nurse is at bedside titrating to hemodynamics, giving fluids, assessing and monitoring this pt continuously with swans, PAOP, adjusting timing and triggers on IABP's ect. Now who is managing this pt at this point in time. The MD isnt at the bedside adjusting drips to the pts pressures and status. So by merely saying start vaso and epi yes he is taking part in the management of that pt but so is the Nurse that actually sits at the bedside to see the response to the drug and titrates it and fluids and opiods and CVVHD UF rates accordingly to optimize whatever function we can.

Now dont get me wrong I know anesthesiologist do this all day and night in the OR and even as intensivist in the ICU. Anesthesia practitioners in general give their drugs, assess, counter side effect, manipulate and balance just about every system in the human body. Thats why they are unique. They take action, wait to see the immediate results of their action and then intervene and tweak or counter or prevent this and that. My point is that ICU nurse plays a much larger role than you think. Its not the drips that you ordered for this pt b/c any MD would have probrably ordered the same thing. Its how the drips, drugs and fluids and devices are administered, manipulated and titrated to every freaking v/s, pressure, LOC, UO change that really makes the difference in this case. Put a RN that doesnt no jack shiznit managing a Pt like this and he will crump for sure no matter what freaking drugs the MD orders. BUt a seasoned ICU nurse managing them and with good collaboration b/t the MD and manipulation and adjustment by the RN this pt has a way better chance of pulling thru.

 

[nitecap]

and you understand that requiring everyone to be board certified by the ABA would immediately put all CRNA's out of commission, since to be ABA certified means you have to be a physician first.

I am for it.

Tough

you know as good as anyone that nurse anesthesia is the practice of nursing not medicine. We are certified by nursing regulatory bodies, and 100% of us.

And 1 pt a day you ask? Actually its usually 2 unless you are managing a total train wreck or fresh VAD or something. Anything more than 2 if unstable would be very unsafe. Sorry you cant manage 5-10 super sick pts doing everything for them from turning, to manipulating drips, feedings, fluids, hygene plus actually interacting with family. Believe me mortailty rates would be thru the roof if that were the case. I can definetly tell you have spent little time maybe even not set foot in a busy ICU.

 

[toughlife]

SO quick question. Pt has crapped out after a CAB and on mega drips that the MD ordered. However Nurse is at bedside titrating to hemodynamics, giving fluids, assessing and monitoring this pt continuously with swans, PAOP, adjusting timing and triggers on IABP's ect. Now who is managing this pt at this point in time. The MD isnt at the bedside adjusting drips to the pts pressures and status. So by merely saying start vaso and epi yes he is taking part in the management of that pt but so is the Nurse that actually sits at the bedside to see the response to the drug and titrates it and fluids and opiods and CVVHD UF rates accordingly to optimize whatever function we can.

Now dont get me wrong I know anesthesiologist do this all day and night in the OR and even as intensivist in the ICU. Anesthesia practitioners in general give their drugs, assess, counter side effect, manipulate and balance just about every system in the human body. Thats why they are unique. They take action, wait to see the immediate results of their action and then intervene and tweak or counter or prevent this and that. My point is that ICU nurse plays a much larger role than you think. Its not the drips that you ordered for this pt b/c any MD would have probrably ordered the same thing. Its how the drips, drugs and fluids and devices are administered, manipulated and titrated to every freaking v/s, pressure, LOC, UO change that really makes the difference in this case. Put a RN that doesnt no jack shiznit managing a Pt like this and he will crump for sure no matter what freaking drugs the MD orders. BUt a seasoned ICU nurse managing them and with good collaboration b/t the MD and manipulation and adjustment by the RN this pt has a way better chance of pulling thru.

and what do you do when all your manipulations are not working?

 

[toughlife]

Tough

you know as good as anyone that nurse anesthesia is the practice of nursing not medicine. We are certified by nursing regulatory bodies, 100% of us.

Well, how about if we require all anesthesiologists and CRNAs to take both sets of boards and whoever passes them both can practice?

is that fair?

 

[nitecap]

Collaborate, believe me Im not to proud to ask for help when I need it. And again both are equally vital in the management of the patient. the pt will do best with a competent MD and RN. Just as there are incompetent RN's there are incompent MD's believe me.

Please dont lie, as a med student you had maybe given a handful of IVP drugs and actually stayed around to see what happened. Now you push drugs and assess responses all day.

 

[nitecap]

Well, how about if we require all anesthesiologists and CRNAs to take both sets of boards and whoever passes them both can practice?

is that fair?

Sounds fair enough. As long as both are given direction on how to prep for each exam and given ample time to prepare. I think its fair. Doubt one could just waltz in to the CRNA cert exam without studying a lick and ace it. Especially a resident CA-1 or 2.

On that note really looking forward to taking neuroscience with the med students my next 2 blocks. I already have some friendly bets on the table with a few MS-1 buddies of mine.

 

[jetproppilot]

Sounds fair enough. As long as both are given direction on how to prep for each exam and given ample time to prepare. I think its fair. Doubt one could just waltz in to the CRNA cert exam without studying a lick and ace it. Especially a resident CA-1 or 2.

On that note really looking forward to taking neuroscience with the med students my next 2 blocks. I already have some friendly bets on the table with a few MS-1 buddies of mine.

Whatcha tryin to prove here, Dude? If you feel the need to sound intellectual by posting on a doctor forum that you can hang with MS1s, congrats. OK, you can hang. But until you step up to the mike with Micatin and endure the rigors of pre-med, MCAT preparation, med school and residency, your posts will continue to convey internal conflict and inferiority.

Let me put this as eloquently as possible. You are giving CRNAs a bad name with your incessant antagonistic, propaganda filled posts. The only posts I see from you are defensive, and then they turn offensive in nature.

What was once a forum filled mostly with informative threads now focuses on the CRNA vs MD bulls hit.

I've told you this before, Slim, and I'm gonna say it again, because apparently you havent figured it out...don't expect to come to a doctor forum with your, as I'm sure you see them, "prophetic" posts, and expect people to buy into them. Mind as well be a member of the NAACP posting on a KKK website.

I've stayed out of these recent threads cuz I tell myself, "Jet, it doesnt do any good."

But is that the right thing to do? To let SRNA (geez...and that humors me..that youre not even done with your training and you're so vocal) terrorists infiltrate this forum??

I'm rethinking my silence.

Maybe its time to begin, AGAIN, retaliation, and bounce you a ssholes outta here...and I know, we cant remove you...but we CAN respond in ways that'll surely close the threads that youre posting on.

And since you ONLY post on propaganda threads, and rarely post anything useful and informative, thats good enough for me.

Thats the new tactic against the terrorists, my MD, preMD, (rational) CRNAs, and AAs colleagues.

If Slim and his buddies start gettin outta hand, post in a fashion that'll force Venty to close the thread.

I'm sick, and VERY tired of this VERY GREEN, chihuaha like, s hit stirring, arrogant, never-ending, propaganda pushing, inferiority complex ridden individual.

 

[fishtolive]

Sounds fair enough. As long as both are given direction on how to prep for each exam and given ample time to prepare.

just like a nurse...always needing direction and taking their sweet ass time. why not take step 1 and 2 this year for fun and see how well you do, tough guy?

skim and 1 sugar please.

close this forum!

 

[Monty Python]

POLITICAL SCIENCE 401 CASE STUDY:
OUTSIDE INFLUENCES ON ANESTHESIA MANPOWER AND STAFFING

Preface / disclaimer: This is written from a business perspective only, as if I was a bean counter and not in anesthesia myself:

Very very few patients come to the hospital strictly for an anesthetic (epidural steroid injections, etc). The vast majority come for a surgical procedure which requires our involvement. The patients belong to the surgeon, not to us. Please keep that in mind as you read below.

Most surgeons couldn't give a rodent's gluteus about who is behind the ether screen. All they care about is anesthesia's:

1. availability
2. affability
3. ability

usually in that order. (I did not make that up, but I cannot recall who the original author is for proper credit to be given).

There are some surgeons who do limit their anesthesia to specific providers.

Right now there are BARELY enough providers (anesthesiologists, CRNAs, AAs) to cover the stools. Current graduation-versus-retirement rates are not encouraging. The graying of the baby boomers only means greatly increased demand for anesthesia service over the next several decades.
Everyone on this forum is assumed to be intelligent, you do the math yourself.

Implementing some of the previous posters' proposals would greatly reduce anesthesia's overall availability, AND THE SURGEONS WILL NOT STAND FOR THAT. While we can discuss and debate ad nauseum the pros and cons of the current anesthesia workforce, licensure, and scope of practice, I can guarantee the surgeons will get involved FOR THEIR BENEFIT if anything reduces their operating room time, due to limited anesthesia manpower which is a result of political decisions.

Speaking strictly apolitically here, some surgeons are rural CRNAs' strongest policitical supporters, because there are no anesthesiolgists in their particular boonies. Restrict those CRNAs and you'll have very mad surgeons on your hands. This is offered as an apolitical point of fact: one very rural hospital where I moonlight (and has no anesthesiologist availability) has a surgeon who is retired military. He's used to seeing only CRNAs in front line combat hospitals. He's told me that lots of his surgeon peers will lobby Congress directly if any attempts are made to restrict CRNA practice in civilian life, based on how Uncle Sam himself uses unsupervised CRNAs in front line combat hospitals.

There have been numerous rationales given in this thread for the pros and cons of various licensure restrictions, supervision requirements, independence versus dependence, etc. My sole purpose for this sermonette is to get everyone thinking about the global situation from an economic perspective, especially when decisions we make within the anesthesia community can negatively affect (ie, piss off) other user groups such as the surgeons who will not tolerate any negative influence on their OR time and hospital administrators who can't afford reduction in OR profit.

 

[cloud9]

Sounds fair enough. As long as both are given direction on how to prep for each exam and given ample time to prepare. I think its fair. Doubt one could just waltz in to the CRNA cert exam without studying a lick and ace it. Especially a resident CA-1 or 2.

On that note really looking forward to taking neuroscience with the med students my next 2 blocks. I already have some friendly bets on the table with a few MS-1 buddies of mine.

And on an equally relevant note, I just saved a bunch of money by switching to GEICO.

We've had this song and dance before, second verse same as the first.

 

[underdog27]

Whatcha tryin to prove here, Dude? If you feel the need to sound intellectual by posting on a doctor forum that you can hang with MS1s, congrats. OK, you can hang. But until you step up to the mike with Micatin and endure the rigors of pre-med, MCAT preparation, med school and residency, your posts will continue to convey internal conflict and inferiority.

Let me put this as eloquently as possible. You are giving CRNAs a bad name with your incessant antagonistic, propaganda filled posts. The only posts I see from you are defensive, and then they turn offensive in nature.

What was once a forum filled mostly with informative threads now focuses on the CRNA vs MD bulls hit.
I've told you this before, Slim, and I'm gonna say it again, because apparently you havent figured it out...don't expect to come to a doctor forum with your, as I'm sure you see them, "prophetic" posts, and expect people to buy into them. Mind as well be a member of the NAACP posting on a KKK website.

I've stayed out of these recent threads cuz I tell myself, "Jet, it doesnt do any good."

But is that the right thing to do? To let SRNA (geez...and that humors me..that youre not even done with your training and you're so vocal) terrorists infiltrate this forum??

I'm rethinking my silence.

Maybe its time to begin, AGAIN, retaliation, and bounce you a ssholes outta here...and I know, we cant remove you...but we CAN respond in ways that'll surely close the threads that youre posting on.

And since you ONLY post on propaganda threads, and rarely post anything useful and informative, thats good enough for me.

Thats the new tactic against the terrorists, my MD, preMD, (rational) CRNAs, and AAs colleagues.

If Slim and his buddies start gettin outta hand, post in a fashion that'll force Venty to close the thread.

I'm sick, and VERY tired of this VERY GREEN, chihuaha like, s hit stirring, arrogant, never-ending, propaganda pushing, inferiority complex ridden individual.

I agree....Why do you spend so much time posting on topics like this. You are not going to change their way of thinking, just as they would not change the CRNA's way of thinking at allnurses.com. So give it a rest already!!

 

[dogbone65]

Whatcha tryin to prove here, Dude? If you feel the need to sound intellectual by posting on a doctor forum that you can hang with MS1s, congrats. OK, you can hang. But until you step up to the mike with Micatin and endure the rigors of pre-med, MCAT preparation, med school and residency, your posts will continue to convey internal conflict and inferiority.

Let me put this as eloquently as possible. You are giving CRNAs a bad name with your incessant antagonistic, propaganda filled posts. The only posts I see from you are defensive, and then they turn offensive in nature.

What was once a forum filled mostly with informative threads now focuses on the CRNA vs MD bulls hit.

I've told you this before, Slim, and I'm gonna say it again, because apparently you havent figured it out...don't expect to come to a doctor forum with your, as I'm sure you see them, "prophetic" posts, and expect people to buy into them. Mind as well be a member of the NAACP posting on a KKK website.

I've stayed out of these recent threads cuz I tell myself, "Jet, it doesnt do any good."

But is that the right thing to do? To let SRNA (geez...and that humors me..that youre not even done with your training and you're so vocal) terrorists infiltrate this forum??

I'm rethinking my silence.

Maybe its time to begin, AGAIN, retaliation, and bounce you a ssholes outta here...and I know, we cant remove you...but we CAN respond in ways that'll surely close the threads that youre posting on.

And since you ONLY post on propaganda threads, and rarely post anything useful and informative, thats good enough for me.



Thats the new tactic against the terrorists, my MD, preMD, (rational) CRNAs, and AAs colleagues.

If Slim and his buddies start gettin outta hand, post in a fashion that'll force Venty to close the thread.

I'm sick, and VERY tired of this VERY GREEN, chihuaha like, s hit stirring, arrogant, never-ending, propaganda pushing, inferiority complex ridden individual.

I've been a RN for, oh, 13 years. CVICU, trauma, etc. I start crna school in a year...long been a dream. I ran into this site and have found some good info. I'm too damn old and perhaps cynical to get into all this nanny nanny boo boo crap. I've enjoyed some of nitecap's post here and elsewhere, but jet you are right. Chill out nitecap. There are Sh#$y docs and sh#$@#%y nurses just as there are those that are exceptional. Take that chip off your shoulder because you are giving us all a bad name and headache. And jet as far as you, enjoy the posts, are interesting and I enjoy learning, sounds like you have a good head on your shoulders, rather than a chip, and would love to work with someday.