CRNA exam

[Justin4563]

This is just an observation

CRNA exam is one day and i believe 160 questions

the aba certification exam is one day and 400 questions.. then oral boards....

the crna exam is given several times a year.. the aba exam only once a year

anesthesiologists are physicians... with 8 years formal education with 4 more years of residency training.. CRNA is a masters program with some not even finishiing college... let alone taking the grueling hard science classes.. such as advanced physics, advanced mathematics. granted there are some who have the ability to accomplish this but the fact is that they did not..

"IF you wanna be captain, go to captain school"

you tell me who is more qualified...


I can teach the nursing assistant to put in a swan.. does that make it a good idea NO..

I can drive with my feet.. does that make it a good idea... the answer is NO

any surgical pa with experience can remove your appendix.. do you want them doing that.????

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[sones]

This is just an observation

CRNA exam is one day and i believe 160 questions

the aba certification exam is one day and 400 questions.. then oral boards....

the crna exam is given several times a year.. the aba exam only once a year

anesthesiologists are physicians... with 8 years formal education with 4 more years of residency training.. CRNA is a masters program with some not even finishiing college... let alone taking the grueling hard science classes.. such as advanced physics, advanced mathematics. granted there are some who have the ability to accomplish this but the fact is that they did not..

"IF you wanna be captain, go to captain school"

you tell me who is more qualified...


I can teach the nursing assistant to put in a swan.. does that make it a good idea NO..

I can drive with my feet.. does that make it a good idea... the answer is NO

any surgical pa with experience can remove your appendix.. do you want them doing that.????

what is your point about the CRNA exam???? Are CRNAs physicians? No, does that make them poor providers....again NO. As for whether they completed college...you're obviously showing your ignorance, who gets a Masters degree without completing a college degre...NO ONE. One of the requirements for as nurse to become a CRNA is a BACHELORS DEGREE. So, get your facts straight prior to making your observations. Also, the CRNA exam has fewer questions...fewer chances to make up for the ones you miss. And, in most states, the CRNA exam is only offered twice a year if at all. And you're right, physicians have a lot more BOOK education in taking care of patients. CRNAs have the valuable education of patient education to assist them. You're right, it's not physiology, its different, but its valuable, and you MDs forget that valuable education. So, if you want to compare education, four years of undergraduate, four years of ICU experience + another year of sciences, then three years of additional education. Hummmm...that looks like 11 years of education next to your 12...their different, but almost the same amount. NOw, I'm not saying I"m a physician or that I am as educated as you are as an MDA...but, I think you need to look at the CRNAs you work with and respect them for their knowledge base. ANd WHY do these same discussions keep popping up and WHY DO I KEEP RESPONDING TO THEM!!!! 😳

 

[Justin4563]

it keeps popping up because crnas are saying that they are equal to and md which is not the truth.. It just plain isnt.. IF it is.. lets get rid of medical school and residency and dumb medicine down.. WHich is what crna=md is.. YOu dumb it down saying you dont need as much education to do the same job.. THis is very very dangerous.. "If you wanna be captain, go to captain school"

 

[jwk]

This is just an observation

CRNA exam is one day and i believe 160 questions

the aba certification exam is one day and 400 questions.. then oral boards....

And an MD can fail their board exams several times and still practice, where a CRNA or AA fail their's once and are on the sidelines until the next exam comes around and they receive their scores.

I can teach the nursing assistant to put in a swan..

Actually, no, you can't.


I always think it's funny when residents or newly ex-residents think they know everything.

Try and understand that most CRNA's do NOT think they're better than MD's. That's a radical but vocal minority.

 

[UTSouthwestern]

Correct me if I'm mistaken, but aren't the CRNA boards given 7 times a year at Sylvan Learning Centers? I read this post against my better judgement (there are enough of these threads on this board), and I recall that our CRNA's mentioned that they almost felt like they were cheating because the exam was so similar to something called the "Valley Review Course" text and question review which is/was a one to two day review course with take home material.

We have a unique perspective in that one of our VA faculty was a CRNA who went to medical school and went through an anesthesiology residency in California (San Diego I believe). She felt that the CRNA board exam was quite a bit easier than her written anesthesiology board exam and she too only used the Valley Review to easily pass her CRNA boards. By contrast, she failed her written boards for anesthesiology (but eventually passed later). Her perspective given her extensive clinical background in both professions has been to refute any attempts to compare the clinical experience and education between a CRNA and MD.

Also correct me if I'm mistaken, but the number of ICU years required before going to CRNA school is ONE not four. I don't want to go into the differences in clinical experiences among different services, but I do feel that our experiences in medical school and internship and/or other residency (IM for myself) do provide a very broad range of clinical skills beyond what basic physiology and even our first year of clinical anesthesiology provides. How one uses that experience can be variable, but at least having had those experiences enriches a person's background and skills.

My 2 cents.

 

[Justin4563]

I guess sones has no refute.. because he knows better..

and the only reason crnas have more power than they do is because of anesthesiologists... we created the beast.. once the younger generation comes out they will be put in their place.. all physician groups contracting with hospitals.. encouraging resident education and increasing the number of anesthesiology positions.. including encouraging foreign born physicians to come to the united states to practice anesthesiology... Crnas will become the minority.... DONT DUMB DOWN MEDICINE>> ITS DANGEROUS...

 

[ether_screen]

Advanced math?hmmmm?when a certain percentage is required to pass an exam, the number of questions if completely irrelevant. Perhaps Justin may want to consult his high school statistics book.

But in all seriousness, the cost-containment powers that be will arrive at the conclusion that MDAs are many times over qualified to perform a large majority of cases. Hence, the anesthesia care team model will continue to thrive, or solo practice CRNA situations will become even more common. The fact that none of the opt out states have changed positions to opt-in over the past two years speaks volumes.

The minimum for entry to a master?s nurse anesthesia program is 1-2 years depending on the individual program. By no means does this exclude people with more experience, as these are often the individuals who gain acceptance.

 

[powermd]

what is your point about the CRNA exam???? Are CRNAs physicians? No, does that make them poor providers....again NO. As for whether they completed college...you're obviously showing your ignorance, who gets a Masters degree without completing a college degre...NO ONE. One of the requirements for as nurse to become a CRNA is a BACHELORS DEGREE. So, get your facts straight prior to making your observations. Also, the CRNA exam has fewer questions...fewer chances to make up for the ones you miss. And, in most states, the CRNA exam is only offered twice a year if at all. And you're right, physicians have a lot more BOOK education in taking care of patients. CRNAs have the valuable education of patient education to assist them. You're right, it's not physiology, its different, but its valuable, and you MDs forget that valuable education. So, if you want to compare education, four years of undergraduate, four years of ICU experience + another year of sciences, then three years of additional education. Hummmm...that looks like 11 years of education next to your 12...their different, but almost the same amount. NOw, I'm not saying I"m a physician or that I am as educated as you are as an MDA...but, I think you need to look at the CRNAs you work with and respect them for their knowledge base. ANd WHY do these same discussions keep popping up and WHY DO I KEEP RESPONDING TO THEM!!!! 😳

I love responses from midlevels that attempt to compare the experience of training as a physician to the experience of training as a nurse- as if the two were in any way equal. Physicians are trained from the beginning as decisionmakers who will eventually have to assume total responsibility for patient care. Add to that the fact that competition for med school admission keeps the bar set very high in terms of brains and dedication. Nurses are trained as care-givers with the knowledge that there will always be someone to back them up. I rarely, if ever see the same cavelier attitude from fellow physicians that I see in nurses who think they can do it all. From what I've seen, the bar for admission to the nursing profession is set very, very low. My hospital suposedly has some of the best nursing care in the state. Everytime I hear about this I have to laugh because of what I see on the floors. My god are these people dumb! Perhaps 10% of the nurses I deal with daily know what they're doing and are effective providers of nursing care. The rest are an embarassment to the profession. ICU nurses tend to be brighter and more able, but they still approach patient care from a nursing perspective (care-giving vs. decisionmaking).

 

[sones]

I guess sones has no refute.. because he knows better..

and the only reason crnas have more power than they do is because of anesthesiologists... we created the beast.. once the younger generation comes out they will be put in their place.. all physician groups contracting with hospitals.. encouraging resident education and increasing the number of anesthesiology positions.. including encouraging foreign born physicians to come to the united states to practice anesthesiology... Crnas will become the minority.... DONT DUMB DOWN MEDICINE>> ITS DANGEROUS...

Hummmmm...sones is a SHE not a he!!! and MDs did not create the beast!!!! The beast exited on its own...... and, considering the lack of anesthesia providers in the US, I highly doubt you will be seeing CRNAs becoming the minority. Actually, I think you will begin seeing AAs gaining more and more ground. I think they are the profession to watch. As for Dumbing down medicine....how was I doing that?? And if I was, how is it dangerous?

 

[sones]

I love responses from midlevels that attempt to compare the experience of training as a physician to the experience of training as a nurse- as if the two were in any way equal. Physicians are trained from the beginning as decisionmakers who will eventually have to assume total responsibility for patient care. Add to that the fact that competition for med school admission keeps the bar set very high in terms of brains and dedication. Nurses are trained as care-givers with the knowledge that there will always be someone to back them up. I rarely, if ever see the same cavelier attitude from fellow physicians that I see in nurses who think they can do it all. From what I've seen, the bar for admission to the nursing profession is set very, very low. My hospital suposedly has some of the best nursing care in the state. Everytime I hear about this I have to laugh because of what I see on the floors. My god are these people dumb! Perhaps 10% of the nurses I deal with daily know what they're doing and are effective providers of nursing care. The rest are an embarassment to the profession. ICU nurses tend to be brighter and more able, but they still approach patient care from a nursing perspective (care-giving vs. decisionmaking).

I love the responses from medical students and residents who think they know it all. First of all, I never attempted to state that a CRNA is better qualified to care for a patient than an MDA. I am simply trying to get you MDs to stop downplaying my education!! And for your information, the competition for CRNA school is nothing to poo poo. It is a tough competition. You're right, about something for once, the bar for nursing is set quite low....someone has to care for your patients...but the bar for CRNAs 1000 times higher. Oh, and thanks for the respect of mankind and calling people dumb. I['m sure you know the whole story and you are qualified to make that judgement call. And...nurses approach patients from a care-giving perspective....maybe you should try it...since you are a patients CARE GIVER!!! As for decision making, we make the decision within our scope of practice..whether that be anesthetic decisions or nursing decisions.

 

[sones]

Correct me if I'm mistaken, but aren't the CRNA boards given 7 times a year at Sylvan Learning Centers? I read this post against my better judgement (there are enough of these threads on this board), and I recall that our CRNA's mentioned that they almost felt like they were cheating because the exam was so similar to something called the "Valley Review Course" text and question review which is/was a one to two day review course with take home material.

We have a unique perspective in that one of our VA faculty was a CRNA who went to medical school and went through an anesthesiology residency in California (San Diego I believe). She felt that the CRNA board exam was quite a bit easier than her written anesthesiology board exam and she too only used the Valley Review to easily pass her CRNA boards. By contrast, she failed her written boards for anesthesiology (but eventually passed later). Her perspective given her extensive clinical background in both professions has been to refute any attempts to compare the clinical experience and education between a CRNA and MD.

Also correct me if I'm mistaken, but the number of ICU years required before going to CRNA school is ONE not four. I don't want to go into the differences in clinical experiences among different services, but I do feel that our experiences in medical school and internship and/or other residency (IM for myself) do provide a very broad range of clinical skills beyond what basic physiology and even our first year of clinical anesthesiology provides. How one uses that experience can be variable, but at least having had those experiences enriches a person's background and skills.

My 2 cents.

Your right, the number of years required for CRNA school is one....rarely do these people actually get into school. Most have at least 2 if and the more is the majority.

 

[UTSouthwestern]

Thanks for your reply. I'd say about half of ours did one, the rest more.

 

[Justin4563]

Hummmmm...sones is a SHE not a he!!! and MDs did not create the beast!!!! The beast exited on its own...... and, considering the lack of anesthesia providers in the US, I highly doubt you will be seeing CRNAs becoming the minority. Actually, I think you will begin seeing AAs gaining more and more ground. I think they are the profession to watch. As for Dumbing down medicine....how was I doing that?? And if I was, how is it dangerous?

Ok sones. You are dumbing down medicine by saying the medical education is not necessary to provide care to the surgical patient. Furthremore, implying that every single patient who is rendered anesthetized does not deserve a medical physician ; a crna education will suffice. THats dumbing down medicine. And in my opinion, if an md cant be present for my anesthetic, take me elsewhere..

IF there was a surgical shortage, would you train PAs to take out your appendix or place chest tubes or do thoracotomies.. No you wouldnt. You woulld go elsewhere.

I dont care how routine something looks. To the patient, nothing is routine. And in fact nothing in medicine is routine.
Giving crnas autonomy is a complete disservice to patients everywhere.
it really is a shame.. I know crnas want more power and autonomy. If that is desired; you should sweat it out for fouryears in medical school and residency.

 

[powermd]

I love the responses from medical students and residents who think they know it all. First of all, I never attempted to state that a CRNA is better qualified to care for a patient than an MDA. I am simply trying to get you MDs to stop downplaying my education!! And for your information, the competition for CRNA school is nothing to poo poo. It is a tough competition. You're right, about something for once, the bar for nursing is set quite low....someone has to care for your patients...but the bar for CRNAs 1000 times higher. Oh, and thanks for the respect of mankind and calling people dumb. I['m sure you know the whole story and you are qualified to make that judgement call. And...nurses approach patients from a care-giving perspective....maybe you should try it...since you are a patients CARE GIVER!!! As for decision making, we make the decision within our scope of practice..whether that be anesthetic decisions or nursing decisions.

Dumb:
If you heard what nurses call me for in the middle of the night you would agree that they are very stupid, lazy people. I just got up to answer a page from a nurse because one of my patients is retching. She already has a PRN order in the chart for Zofran that I wrote last night. Instead of checking her PRN med list, the nurse paged me instead. Stupid. Lazy. Another patient of mine was due to have cardiac enzymes rechecked at 10pm last night. After not seeing the results for a few hours in the computer, I went back to ask when the blood was drawn. At 2am the blood had still not been drawn. The nurse's excuse was- "oh, I was busy I had THREE admissions". Stupid. Lazy. And apparently- not very caring for a "care-giver". I could go on and on with stories like this. It has happened every night I've been floating this month. I do feel qualified to make the judgment that these nurses are stupid, lazy, and an embarrasment to good nursing care.

As for me needing to "try care-giving", that's getting a bit personal. You don't know me at all. If you did, you would be impressed with how much I care, and how much effort I put into doing the best I can for patients. I was called tonight to see a supposedly very difficult patient who had been refusing treatment for two days despite being very ill. I spoke with him for ten minutes (I listened for five) and guess what? He accepted all the treatments I needed to give him.

When I speak of the difference in perspective and training between MDs and RNs, I'm not referring to caring about patients. That is the basis of the entire medical profession- a caring relationship between provider and patient. I'm talking about caring as a verb- the work that nurses do to support physical health, collect data, monitor patients, and provide treatments. Physicians are trained to make strategic patient care decisions, and provide comprehensive treatments (procedures, etc). Nurses are not trained to think at this level because this is not relevant to the work they do. It doesn't suprise me when nurses freak out because they don't understand a patient care order (they do, frequently). They don't see the larger picture that physicians do with their wide knowledge base, and orientation toward strategic decisionmaking. I don't say any of this to disparage nursing care- it's vital to maximizing the efficiency and effectiveness of health care delivery. I feel blessed whenever I get to work with a good nurse that knows his/her role, and also knows mine. I'm just saying that in my experience, few nurses at my hospital do their own jobs very well, let alone somehow being equivilant to even the most dim-witted physician.

 

[jwk]

Dumb:
If you heard what nurses call me for in the middle of the night you would agree that they are very stupid, lazy people.

And if you haven't figured it out yet, nurses sometimes call residents in the middle of the night because the residents sometimes tend to be jerks and it's the nurses way of getting back at them. I would have thought you learned that in medical school.

And if you read the single line above that I just quoted from your post, it speaks volumes to your attitude about non-physicians. Good luck once you enter the real world.

 

[jwk]

Correct me if I'm mistaken, but aren't the CRNA boards given 7 times a year at Sylvan Learning Centers? .

The AA exam is given once a year, in Cleveland or Atlanta only. Fail and you have to sit out a year.

 

[powermd]

And if you haven't figured it out yet, nurses sometimes call residents in the middle of the night because the residents sometimes tend to be jerks and it's the nurses way of getting back at them. I would have thought you learned that in medical school.

And if you read the single line above that I just quoted from your post, it speaks volumes to your attitude about non-physicians. Good luck once you enter the real world.

Every medical student knows this before we even come near a hospital. I just started floating this week. None of the nurses who page me incessantly knew me before this week, so their behavior has nothing to do with my attitude toward them. I know the risks of giving attitude to nurses so I am always friendly and courteous. I have heard from residents that nurses try to get away with a lot of crap early on in the year because they know interns are ignorant of what nurses can and can't do. Who is it that has the attitude problem? I work hard and do my job well. It pains me to watch nurses huff and puff over having to lift a finger to help a sick patient. Last night a nurse paged me to evaluate a man with chest pain- "you really need to come see him." When I did, and asked if she could check the vitals before I decide what to do, she rolled her eyes and huffed. How professional is that, smartypants? What attitude should I have toward people whose job it is to help the sick but obviously don't care enough to follow up important patient care orders?

Hey, I'm a fair guy- I don't intend to paint all RNs with the same broad brush I think applies to the folks I work with now. I just haven't yet worked at a hospital where most of the RNs are effective care providers. We can't even begin to talk about the ways physicians and RNs may be alike if RNs won't do their own jobs well.

 

[sones]

Every medical student knows this before we even come near a hospital. I just started floating this week. None of the nurses who page me incessantly knew me before this week, so their behavior has nothing to do with my attitude toward them. I know the risks of giving attitude to nurses so I am always friendly and courteous. I have heard from residents that nurses try to get away with a lot of crap early on in the year because they know interns are ignorant of what nurses can and can't do. Who is it that has the attitude problem? I work hard and do my job well. It pains me to watch nurses huff and puff over having to lift a finger to help a sick patient. Last night a nurse paged me to evaluate a man with chest pain- "you really need to come see him." When I did, and asked if she could check the vitals before I decide what to do, she rolled her eyes and huffed. How professional is that, smartypants? What attitude should I have toward people whose job it is to help the sick but obviously don't care enough to follow up important patient care orders? And please, this is just a suggestion, don't call people dumb and make it a blanket statement.

Hey, I'm a fair guy- I don't intend to paint all RNs with the same broad brush I think applies to the folks I work with now. I just haven't yet worked at a hospital where most of the RNs are effective care providers. We can't even begin to talk about the ways physicians and RNs may be alike if RNs won't do their own jobs well.

I'm sorry if that comment about trying to care for your patients hit you the wrong way. I'm not trying to imply you don't care about your patients. I have run into too many residents, MDs, interns etc who would rather look at a patient for their body, not for the suffering they are going through and what they can do to correct it. I ran into someone just yesterday who I was evaluating for surgery and the first thing she said to me in the clinic was she wanted to sue every one of the physicians who had cared for her the last 10 years and had not taken her symptoms seriously and dismissed her etc etc etc. Its stories like that that make me angry and get a bad impression of physicians sometimes. I have also had physicians I have worked with hold patient's hands while they cry ,sit with them, and spent time explaining their care. Patients require that and deserve that. As for RNs who don't do their jobs well...sounds like you are in a terrible hospital!!! Maybe it was the background of nursing I have, but if a lab test was ordered it was done and if the patient was retching, I tried my best not to call the MD until I had tried the ondansatron and given it an hour or so to work. As for the nurse who called you about the patient having chest pain, why didn't she do vital signs prior to calling you?? I hope you can find some good nurses to change your opinion...there really are some out there.

 

[sones]

Ok sones. You are dumbing down medicine by saying the medical education is not necessary to provide care to the surgical patient. Furthremore, implying that every single patient who is rendered anesthetized does not deserve a medical physician ; a crna education will suffice. THats dumbing down medicine. And in my opinion, if an md cant be present for my anesthetic, take me elsewhere..

IF there was a surgical shortage, would you train PAs to take out your appendix or place chest tubes or do thoracotomies.. No you wouldnt. You woulld go elsewhere.

I dont care how routine something looks. To the patient, nothing is routine. And in fact nothing in medicine is routine.
Giving crnas autonomy is a complete disservice to patients everywhere.
it really is a shame.. I know crnas want more power and autonomy. If that is desired; you should sweat it out for fouryears in medical school and residency.

I am NOT dumbing medicine. ANd I'm sorry, there are definitely times I would refuse to have and MD do my anesthetic because I have seen how some of them work. Do I think it should be a team approach...um....YEAH!! Do I think a CRNA should do many of the cases that come through by themselves...um...NO. However, unless you are going to work in podunkville nowhere for nothing interms of money, then there will be a CRNA there. ANd if you're in a car accident in that area you'll be glad to have them.
As for whether I think every patient deserves an MD...of course they do, however, with the quality of some of the MDs I have run into....they deserve more than THAT MD. And for your information, they have trained PAs to place CTs and do minor surgery. NPs do it too....oh my gosh!! And I'm doing my own sweating thank you.

 

[Amik25]

Ok, I just want to say that I'm sorry you work with stupid, lazy nurses....we are not all that way. I have worked with SEVERAL stupid, lazy physicians. For example, what about the physician who wanted to give nimbex to a nonintubated patient when I asked for something for his agitation? I calmly said "don't you think he might stop breathing?" What about the physician who came out of his patients room and went up to the UNIT SECRETARY and said "I think she needs help...she is not breathing," and then left the floor? I could go on and on....and I'm sure you could, too. Now, I do not use these examples and say, "See, doctors are stupid. They should not do anesthesia."

 

[Carm]

Why are there CRNA's posting or viewing here. Why do you care what "lazy, immature medical students" are saying about residency programs etc? It just seems strange that a forum about anesthesiologists is so interesting to all of the CRNA's

 

[jwk]

Why are there CRNA's posting or viewing here. Why do you care what "lazy, immature medical students" are saying about residency programs etc? It just seems strange that a forum about anesthesiologists is so interesting to all of the CRNA's

Why wouldn't they? Let's turn it around - why would a "forum about anesthesiologists" (which it isn't) be so interesting to a med student?

And I don't see a single post in this particular thread about residency programs. The very first post in this thread is from an anesthesia resident, making comparisons and negative comments about CRNA's. Neither the title of the thread or this forum is "Hey, We're All Superior MD's, Let's Pat Ourselves on the Back and All Agree with Each Other About Those Who Aren't MD's". It's a DISCUSSION forum, hopefully a civil one. When someone starts off a thread that was obviously posted to 1) declare their own superiority and 2) denigrate the rest, don't expect everyone to agree and don't expect to not be challenged on the opinion. It's a DISCUSSION forum, not a MAKE A STATEMENT forum. The intent is to have a DISCUSSION - and obviously this one is very lively.

And to carm and others:

Both sones and I have attempted to tell you and the others that the big majority of CRNA's (and AA's) do not think of themselves as equal to physicians (nor profess to be) and that both of us work in anesthesia care teams, with physicians, every day, and that regardless of what you may think of us, we are well-educated and well-trained. All you seem to want to do is tell us how much more superior and well educated you are. Gee, it doesn't really take a genius to figure out that you've been in school longer that we have. I fully realize and believe that respect is earned, not bestowed, and so while I wouldn't presume to insist that I have a right to your respect, you should have enough intelligence, with all those years of school, to see that we are not stupid and at least be capable of recognizing the fact that we make more than a minor contribution to the profession.

 

[gasnurse]

Why are there CRNA's posting or viewing here. Why do you care what "lazy, immature medical students" are saying about residency programs etc? It just seems strange that a forum about anesthesiologists is so interesting to all of the CRNA's

gee, we post here because you are discussing crnas. that took a genius to figure out. i find it interesting how much discussion you all have about us. in fact, this thread ended up being more about nurses than crnas. perhaps this one should have been on the nursing forum.

no matter how much discussion occurs, mds, crnas and aas are not going anywhere. there are not enough providers for one group to take over. get used to it. i work in an area where crnas work independently....in a VERY busy 45 bed OB unit. surprisingly enough to all of you, our patients do very well. we also bill and work independently in surgicenters. if we were doing such a bad job do you think our state would have opted out of supervision requirements??? i would have no problem working with mds if that were an option. i've done it in the past and have had a great relationship. the sad fact is if we weren't here practicing the anesthesia for our patients would be lacking or nonexistent in areas such as ours.

i've stated this before, i am not a physician, i am a nurse. i could have gone to medical school if i wanted but chose not to. i will never claim to be a physician. i do my job well and am vigilant with my patient care. perhaps crnas are sick of all the negativity from mds and feel the need to respond to shed some light that despite some bad experiences from some of you we are all not as bad as you would like to believe. in fact, being a bad or good anesthesia provider goes for any group of provider. it is all very individual. and this not only includes technical skills but level of intelligence as well. to assume that just because you went to medical school makes you the most intelligent person on the planet is absurd.

 

[Sinnman]

Guys, I don't think this thread is productive for either side. There is some obvious tension between CRNAs and anesthesiologists but this does not have to turn in to a nurse vs. physician argument. By far and large, in most hospitals the doctors and nurses work great with each other and arguments are a non sequitur.

There is definitely a problem with midlevels pushing for more and more autonomy. All physicians need to be aware of the steady encroachment of midlevels in virtually all medical specialties. I agree with Sones, substituting a physician for a midlevel practitioner will absolutely result in inferior medical care. Granted there may be some hotshot CRNA (NP, AA, PA, CNS, CNM, whatever) that knows their stuff better than some poorly performing physician, but over time and in a large sample, care will suffer.

The problem is blossoming because of action and inaction on both sides. Physicians have become complacent about this threat to the medical profession and to pt care. In fact, doctors helped create these midlevels so they could see more pts and make more $$. Over time, the midlevels have politically pushed for more autonomy, higher reimbursement, and a broader scope.

I think a big problem for the midlevels is that they don't know how much they don't know. I don't mean this disrespectfully, but I experienced this personally. I started out as a Paramedic. For many years, I thought I had a good grasp on emergency medicine (I still knew that the ER docs knew more but not as much as they really do). Then I went to nursing school and realized how much I didn't really know about medicine. After Paramedic and nursing school (including some graduate level NP type classes), I really felt comfortable about my knowledge of medicine. In fact, I really believed that I knew as much as a lot of physicians and I'm not an arrogant person. Well, then I started medical school.... I spent the first quarter amazed of my own ignorance. There is absolutely no comparison in the level of education.

I do not have a chip on my shoulder against midlevels. In fact, I wish everybody would just work together and perform the roles they were originally designed to do. I think NPs, PAs, CRNAs and whoever else can be a valuable asset to the healthcare time. The problem arises when midlevels get too big for their britches and want a bigger piece of the pie without doing the work to deserve it. I also think that as physicians, we need to keep our arrogance in check and respect all healthcare providers as human beings and for the services they provide.

 

[mike327]

I'm unique, I think. At least I am here. I'm an ICU nurse with six years on the job. I'm also a third year med student. I see it from both sides now. More than once I've worked in the day as a med student and the night as a nurse in "the unit". A few observations, please read them all before you get all uptight, there's something here for everybody:

#1: NURSES HAD TO FIGHT LONG AND HARD FOR RESPECT

Don't forget where nursing as a 'career' came from. Young doctors would do well to ask that 30+ year nurse what the job was like in the 60's. Nursing was considered by docs to be a small step up from maid work (nursemaid, look it up) Nurses were expected to stand when the Docs entered the room. If the nurse was using the chart, the doc grabbed it. There was a giant class difference between the well-to-do doctor and the poor nurse that had to work because she couldn't get married. As feminism changed American culture, nursing changed with it.

Nurses had to fight like mad to be considered an important part of medicine. Today nurses tend to be better paid, more men (like me) are nurses, and nurses have much more of a voice. But, respect is a very sensitive issue for nurses. And the 'bad' years out number the 'good' years by a fair margin.


#2: NURSES ARE NOT DOCTORS
Nope, not even close. I'm so so sorry fellow nurses, for what I'm about to say, but nursing school was REALLY REALLY EASY. It is nothing compared to medical school. I went into 3rd year thinking it would be a snap, I've done critical care medicine for six years right? WRONG!!!!! The complexity is beyond compare. All that experience with 'nursing diagnosis' doesn't do jack-S**T when you need to find an antibiotic that works and won't kill their kidneys. Yes, I've watched 100's of central line placements, I could probably do it with minimal supervision. But I was wrong to think that that was all there is to this job. Sure, 'physician extenders' can be trained, in a narrow scope, to do pieces of the physicians job. But ONLY a doctor has the training to put it all together. I never understood, as an ICU nurse, the weight of responsibility that goes into being a doctor. You are the one patients look to to make the decisions. And, try as you might to listen to the nurses around you, patients will blame the doctor for the outcomes, not the nurse.

I feel it now, when I have 10+ patients to round on with a resident breathing down my neck, grading me... Deciding if I'm honors material... I need honors, I have 120,000$ in student loans, I want anesthesia and it's getting competitive...AND THAT F***ING NURSE DIDN'T TOTAL UP THE I&Os!!! Now I'm behind while I chase them down to get the numbers. Now I look disorganized... honors is slipping away...

#3: DOCTORS ARE NOT NURSES

So my GI Bleeding, Parkinsons patient needs a bowel prep for colonoscopy, and I write 'Prep for colonoscopy' and sign the preprinted order sheet. I come in the next day and, as if by magic, the patients ready to go. Ok... DOCTORS have no clue what that involves. None... Sorry fellow med students, but you need to stand there and watch this happen. Just once do a bowel prep on an immobilized Parkinsons patient. Thread that NG tube while they swear at you, then spend the next 10 GO***MN hours shoving fluid up that tube while you clean up those foal smelling BMs that are so big they run off the bed. Then try not to strangle that F**KING med student that comes in at 6am and complains that your other patients DON'T HAVE ANY I&OS CHARTED!!! And, DA**IT that parkinsons patient still isn't clear for the scope!!!



Doctors and Nurses are an odd combination: same patients, different problems. So, generally its best to stay off your high horse, 'cause you really don't have it so bad.

 

[jwk]

Sure, 'physician extenders' can be trained, in a narrow scope, to do pieces of the physicians job. But ONLY a doctor has the training to put it all together.

Doctors and Nurses are an odd combination: same patients, different problems. So, generally its best to stay off your high horse, 'cause you really don't have it so bad.

Overall Mike, I think that was a great post from a very unique perspective. I thought I was a pretty sharp paramedic until I got into anesthesia school and took physiology with the medical students and started down the road of learning the "why" of what I do, not just the "how". I guess my only comment would be in reference to the "narrow scope" part. I fully agree that in the end, the docs have to put the pieces together. I welcome that, I have no problem with that, and it's what I should expect as well.

I don't know your background as far as public vs private hospital, etc., but in private practice, you might be surprised at the "wide scope" of practice that mid-level practitioners now have. We can and probably would disagree on how wide, and of course, that is the source of much of the friction between MD's and the CRNA's (and in particular, their organizations). At one point or another in my 25 years of doing this, I have placed countless central lines, Swans, spinals, epidurals, a few blocks, and even some spinal CSF drains for craniotomy patients. All of those are now outside what the ASA would recommend as an acceptable scope of practice for a non-physician, yet I did them for years. But I also understand the pharmacology and physiology of everything I do, and hope that sets me apart from the "cookbook" approach to anesthesia, that I still unfortunately see from both anesthetists and physicians alike.

Again, great post - and as I've said so many times throughout my posts, we're all here to take care of the patient, and we each have something valuable to contribute.

 

[powermd]

#2: NURSES ARE NOT DOCTORS
Nope, not even close. I'm so so sorry fellow nurses, for what I'm about to say, but nursing school was REALLY REALLY EASY. It is nothing compared to medical school. I went into 3rd year thinking it would be a snap, I've done critical care medicine for six years right? WRONG!!!!! The complexity is beyond compare. All that experience with 'nursing diagnosis' doesn't do jack-S**T when you need to find an antibiotic that works and won't kill their kidneys. Yes, I've watched 100's of central line placements, I could probably do it with minimal supervision. But I was wrong to think that that was all there is to this job. Sure, 'physician extenders' can be trained, in a narrow scope, to do pieces of the physicians job. But ONLY a doctor has the training to put it all together. I never understood, as an ICU nurse, the weight of responsibility that goes into being a doctor. You are the one patients look to to make the decisions. And, try as you might to listen to the nurses around you, patients will blame the doctor for the outcomes, not the nurse.

I feel it now, when I have 10+ patients to round on with a resident breathing down my neck, grading me... Deciding if I'm honors material... I need honors, I have 120,000$ in student loans, I want anesthesia and it's getting competitive...AND THAT F***ING NURSE DIDN'T TOTAL UP THE I&Os!!! Now I'm behind while I chase them down to get the numbers. Now I look disorganized... honors is slipping away...

#3: DOCTORS ARE NOT NURSES

So my GI Bleeding, Parkinsons patient needs a bowel prep for colonoscopy, and I write 'Prep for colonoscopy' and sign the preprinted order sheet. I come in the next day and, as if by magic, the patients ready to go. Ok... DOCTORS have no clue what that involves. None... Sorry fellow med students, but you need to stand there and watch this happen. Just once do a bowel prep on an immobilized Parkinsons patient. Thread that NG tube while they swear at you, then spend the next 10 GO***MN hours shoving fluid up that tube while you clean up those foal smelling BMs that are so big they run off the bed. Then try not to strangle that F**KING med student that comes in at 6am and complains that your other patients DON'T HAVE ANY I&OS CHARTED!!! And, DA**IT that parkinsons patient still isn't clear for the scope!!!

This post from somone with experience training with both the nursing mentality and they physician mentality perfectly illustrates the difference in perspective I tried to capture earlier on. Physicians are primarily trained as decisionmakers, and nurses as care-givers. When both know their role and respect the other, work is efficient, effective, and fun- and no one feels like their toes are being stepped on. My vitriol is directed at the many RNs I have worked with who are not doing their jobs well, or doing it with a bad attitude. Just for example, I have had primarily positive experiences with the nurses at: Northwestern Hospital, Advocate Illinois Masonic Hospital, Glenbrook Hospital, and Highland Park hospital all in and around Chicago. My experiences have not been so positive at Cook County Hospital, Mount Sinai Hospital (Chicago), and at my present place of work, which supposedly has award-winning nursing care (probably based on the ICUs). Everyone of my fellow residents who have worked at hospitals around the NYC area tell me if I think this place has bad nursing, I wouldn't believe how bad it is at hospitals in the city. I can't wait to find out when I move to Columbia next year...

 

[jwk]

[/b]

This post from somone with experience training with both the nursing mentality and they physician mentality perfectly illustrates the difference in perspective I tried to capture earlier on. Physicians are primarily trained as decisionmakers, and nurses as care-givers. When both know their role and respect the other, work is efficient, effective, and fun- and no one feels like their toes are being stepped on. My vitriol is directed at the many RNs I have worked with who are not doing their jobs well, or doing it with a bad attitude. Just for example, I have had primarily positive experiences with the nurses at: Northwestern Hospital, Advocate Illinois Masonic Hospital, Glenbrook Hospital, and Highland Park hospital all in and around Chicago. My experiences have not been so positive at Cook County Hospital, Mount Sinai Hospital (Chicago), and at my present place of work, which supposedly has award-winning nursing care (probably based on the ICUs). Everyone of my fellow residents who have worked at hospitals around the NYC area tell me if I think this place has bad nursing, I wouldn't believe how bad it is at hospitals in the city. I can't wait to find out when I move to Columbia next year...

We could get into the union vs non union or public vs private hospital debate..............naaaahhhhhhhh.

 

[Carm]

Everybody is so touchy. I guess things come across differently in a post, but I was not trying to be a wise guy when I asked why CRNA's etc care so much about what a bunch of med student (and residents) are saying in their forum. I don't know how I got lumped into the whole "hate CRNA" group. It just seems counterproductive. Usually someone will post some negative comment and then it will die out after little or no replies. However, when you answer these posts it just turns nasty. I am sure you are going to say "I just can't let innaccurate posts stand" but who cares? If the result is to change people's minds, I don't think by the tone of the thread that that has happened at all. In fact, it seems that it has drawn in a lot of hostility that is normally not there.

I say this in all seriousness but I know it does not come out accurately in a post, but I ask again why do you care so much? Granted I am not an anesthesiologist, or not even a doctor yet, but I couldn't care less what PA's, nurses, pharmacists, lawyers, teachers etc are saying about doctors or medical students on their forum. I am not saying this in arrogance or defiance, but just saying that the less I care about the things I can't change the happier I am. I doesn't really matter to me what people generalize about my title, but what the people I work with and who know me care and think about me.

I am from a small town in Kansas, and my best friend's dad is one of 6 CRNA's in a group. They are very happy, and very successful. Being small town Kansas, there are no Anesthesiologists in town. They have talked to me about coming back if I go into Anesthesia b/c, these are their words I have no idea whether this is true or not, an MD could add an additional layer to their capabilities. I am not really interested in this, but not because I think they suck. They do all the surgeries in our small town (lap chole's, etc)

I have learned a lot about political ramifications of both groups on these threads. MacGyver has said some things that are really food for thought (dont' hate me for this revelation). I take him just as that, food for thought. It is not like we have to change MacGyvers mind to make aneshthesiology successful. He is just offering an opinion. I don't get all worked up about the things he says b/c what does it matter. He has a lot of points of interest, and a lot of sky falling rhetoric. I just use it as a tool to become more informed, and know that he feels the field is in trouble, but that does not make it so.

Smile everyone

 

[mike327]

Let's all have a hug

Come on, don't be the shy one...

 

[UTSouthwestern]

😍 😍 😍 😍 😍 😍 😍 😍 😍

 

[Justin4563]

I am NOT dumbing medicine. ANd I'm sorry, there are definitely times I would refuse to have and MD do my anesthetic because I have seen how some of them work. Do I think it should be a team approach...um....YEAH!! Do I think a CRNA should do many of the cases that come through by themselves...um...NO. However, unless you are going to work in podunkville nowhere for nothing interms of money, then there will be a CRNA there. ANd if you're in a car accident in that area you'll be glad to have them.
As for whether I think every patient deserves an MD...of course they do, however, with the quality of some of the MDs I have run into....they deserve more than THAT MD. And for your information, they have trained PAs to place CTs and do minor surgery. NPs do it too....oh my gosh!! And I'm doing my own sweating thank you.

you should sweat more.... in medical school... Nobody who has not gone to medical school should be putting in a chest tube.. period.....

 

[sones]

you should sweat more.... in medical school... Nobody who has not gone to medical school should be putting in a chest tube.. period.....

You know, I sweat plenty like I said. If I wanted to be a doctor I would have gone to med school...I prefer to have a life outside of the hospital someday. As for a PA and a chest tube...unfortunately for you, reality is that this type of thing is happening. It has been happening...it will continue to happen. And, your probably dont think anyone who hasn't gone to medical school should be intubating either...better put the MDs on the ambulances.....And since med school qualifies you to put in chest tubes,....I'll as my local pyschiatrist to put in mine next time I have a problem...becuase my ED PA isn't qualified!!!

 

[UTSouthwestern]

Cats and dogs! Living together! Mass hysteria!!!

What happens if the PA dissects through an artery, starts too low and penetrates the diaphragm, overdoses the patient on sedatives and/or narcotics to place the chest tube, etc? What if they fail to recognize these and other complications? What if they recognize them, try to treat them appropriately, but has that treatment mode fail? What then? What if there isn't a physician around when these things occur?

No one would have a psychiatrist place a chest tube if they absolutely did not have to, but you can be sure that he/she has seen them placed, understands the risks and benefits involved, more than likely has placed one at some point in their training, and will have the good sense to defer to a medical or surgical colleague.

Breadth and depth of medical knowledge defines the purpose of medical school with residency available to sharpen specific subsets of skills, information, and decision making processes.

By contrast, an EMT will never deliver anesthesia, a CRNA would never deliver a baby, and a midwife would never intubate a patient (reliably), none of which they would be expected to do, but a physician has the knowledge and past experience in EVERY field of medical care to at least attempt these procedures and manage the potential complications.

 

[mike327]

Damn, I leave for an hour and you guys get all harsh again... It's all about the love man the love

If you want to get really nasty there's a thread about Bush vs. Kerry also. Very snippy indeed...

 

[Sinnman]

I've had a revelation. All this time I have been concerned about the increasing scope and autonomy of the midlevels, but that's not the problem. The problem is the attitude, the I can do everything you can attitude. I guess there is a lot of truth to that. In fact, I bet we could teach an LPN to do chest tubes in one day, central lines in a couple of hours, and a lap appy in two days. Lowered healthcare cost for us all!!!!!!!!!!!!!

Scary, just plain scary.

BTW, UTSouthwestern while I agree with your thoughts, you're wrong about something: EMT's do deliver anesthesia and they do it in many (most?) states as rapid sequence intubation.

 

[powermd]

I've had a revelation. All this time I have been concerned about the increasing scope and autonomy of the midlevels, but that's not the problem. The problem is the attitude, the I can do everything you can attitude. I guess there is a lot of truth to that. In fact, I bet we could teach an LPN to do chest tubes in one day, central lines in a couple of hours, and a lap appy in two days. Lowered healthcare cost for us all!!!!!!!!!!!!!

I agree. I am most bothered by nurses, or mid-levels, who think their skills are, for all practical purposes, equivilant to a physician's. That kind of arrogance makes my blood boil because it puts patients in danger. That mid-levels don't recognize this danger is frightening, and a should be a major impetus for physicians to enter the political fight against mid-level autonomy. I do recognize that the mid-levels seeking autonomy are a vocal minority, but unopposed, they will have their way.

 

[jwk]

I agree. I am most bothered by nurses, or mid-levels, who think their skills are, for all practical purposes, equivilant to a physician's. That kind of arrogance makes my blood boil because it puts patients in danger. That mid-levels don't recognize this danger is frightening, and a should be a major impetus for physicians to enter the political fight against mid-level autonomy. I do recognize that the mid-levels seeking autonomy are a vocal minority, but unopposed, they will have their way.

Nurses are NOT mid-level providers. Try and get your distinctions between personnel correct.

None of you are reading the posts on here from the mid-levels without adding your own interpretation and expanding on what you think we're thinking. I AGREE with you on most of your concerns. But many of you, maybe due to your own "newness" in medicine, obviously don't realize what has already been happening for a number of years. PA's and chest tubes? Hardly a new thing. (and I'm sure they learned before they ever did one to go OVER the rib, not UNDER - duh) EMT's and intubations? Let's see, I did that more than 25 years ago. And as far as some of the more routine anesthesia procedures, CRNA's and AA's have been placing epidural, spinals, and swans for decades. And yes, we know how to manage the complications. Give us a little credit, will ya? We are not simply technicians. If we were, we wouldn't be paid more than you in some cases.

Do you see any of the mid-levels posting here advocating that LPN's do surgery? No! It's ridiculous, yet some of you want to raise that stupid question as if it's a distinct possibility. Get a grip!!!

 

[powermd]

Nurses are NOT mid-level providers. Try and get your distinctions between personnel correct.

I was referring to critical care nurses, who often seem to think they are better than doctors (not in my personal experience, but based on the stories I hear, and what I read in these forums).

None of you are reading the posts on here from the mid-levels without adding your own interpretation and expanding on what you think we're thinking. I AGREE with you on most of your concerns. But many of you, maybe due to your own "newness" in medicine, obviously don't realize what has already been happening for a number of years. PA's and chest tubes? Hardly a new thing. (and I'm sure they learned before they ever did one to go OVER the rib, not UNDER - duh) EMT's and intubations? Let's see, I did that more than 25 years ago. And as far as some of the more routine anesthesia procedures, CRNA's and AA's have been placing epidural, spinals, and swans for decades. And yes, we know how to manage the complications. Give us a little credit, will ya?

I'm not sure what you personally are implying here, but some seem to think that ability to do a technical procedure under the supervision of a doctor (or unsupervised, in rural Kansas), means you essentially providing the same level of care as a physician. Or the ability and legal right to diagnose and treat problems within your narrow scope of practice essentially make you equal to an MD within that scope. Most of us find that a tad cavelier because none of you can possibly know what you don't know. Then you (again, perhaps not jwk personally) cite examples of a dopey acting physician or two, and conclude that medical school is unnecessary to proving comprehensive medical care. I have no problem giving mid-levels credit for their ability to do technical procedures, follow protocols, and think reflexively. I begin to have a problem when they become overconfident and begin to second guess physicians. In some cases they may be right, but in most they are probably wrong.

We are not simply technicians. If we were, we wouldn't be paid more than you in some cases.

Resident pay has little to do with the value of our work. Hospitals pay PAs, NPs, and CRNAs more than residents because they have to- it's a free market. Resident choices of where to work are much more limited, and involve factors like prestige and quality of training, which wouldn't matter if we were just looking to do a job for a paycheck. One could even argue that top academic medical centers could get away with making us pay them to let us work there in some cases. You're not paid more because you're work is more valuable. I'm not sure if that's what you implied, but you should certainly understand that. If resident pay did not involve these other non-monetary factors, and there were more competition between hospitals for residents, pay would certainly go up.

 

[UTSouthwestern]

Sinnman, I meant OR general anesthesia, not field RSI.

 

[endodoc]

Cats and dogs! Living together! Mass hysteria!!!

What happens if the PA dissects through an artery, starts too low and penetrates the diaphragm, overdoses the patient on sedatives and/or narcotics to place the chest tube, etc? What if they fail to recognize these and other complications? What if they recognize them, try to treat them appropriately, but has that treatment mode fail? What then? What if there isn't a physician around when these things occur?

No one would have a psychiatrist place a chest tube if they absolutely did not have to, but you can be sure that he/she has seen them placed, understands the risks and benefits involved, more than likely has placed one at some point in their training, and will have the good sense to defer to a medical or surgical colleague.

I am not a gas resident, but I do like this thread. I am a IM resident.

I can tell you what will happen if the situation happens as you quoted above, you will have lawyers all over the attendings butt, and the PA(midlevel) will have a slap on the wrist, and move to a different ward.
Midlevel are one reason why our country is in a mal practice war! I respect midlevels, but only see them for what they are, midlevel care givers, not decision makers. Granted, there are a select few who can make decisions, but I would not let me medical Lic. ride on trusting one to make a complete decision for me. In many cases midlevels are seen to help ease the work load of a MD, but in turn I do more paperwork. For a 5 min patient visit that a midlevel does, I have 20 min of paperwork, to ensure I will not have a lawyer knocking on my door, or the door of the hospital.


So all in all, I agree with the majority of my fellow MD's on this issue.

 

[jwk]

Resident pay has little to do with the value of our work. Hospitals pay PAs, NPs, and CRNAs more than residents because they have to- it's a free market. Resident choices of where to work are much more limited, and involve factors like prestige and quality of training, which wouldn't matter if we were just looking to do a job for a paycheck. One could even argue that top academic medical centers could get away with making us pay them to let us work there in some cases. You're not paid more because you're work is more valuable. I'm not sure if that's what you implied, but you should certainly understand that. If resident pay did not involve these other non-monetary factors, and there were more competition between hospitals for residents, pay would certainly go up.

Actually, I wasn't referring to resident pay at all, and I didn't say anything about the value of the work. Some groups / centers pay their experienced anesthetists more than some MD's fresh out of residency who are not yet on a partner-track. Certainly not the rule, but not unusual either. Yes, I know, there are some that go straight out of residency to a $400k job, but there are also those who come out starting at $150k or even less.

And yes, I know that some academic centers are so impressed with themselves that they can get away with paying much less. When I finished anesthesia training in the early 80's, there were graduates from my class who received starting salary offers that were higher than some entry-level board-certified academic physicians in the same general locale.

 

[nchhabra]

And if you haven't figured it out yet, nurses sometimes call residents in the middle of the night because the residents sometimes tend to be jerks and it's the nurses way of getting back at them. I would have thought you learned that in medical school.

If this is indeed true, then it speaks poorly on your profession. Imo, this is incredibly inappropriate behavior. You don't call people in the middle of the night to get back at them. The resident/attending may be busy dealing with other patients or doing other important things. If there is a legitimate concern, ie the patient is in pain, nauseated whatever or if it is something the nurse cannot handle, then it is fine. But calling someone in the middle of the night to exact revenge is completely stupid, inappropriate, and immature.

 

[jwk]

If this is indeed true, then it speaks poorly on your profession. Imo, this is incredibly inappropriate behavior. You don't call people in the middle of the night to get back at them. The resident/attending may be busy dealing with other patients or doing other important things. If there is a legitimate concern, ie the patient is in pain, nauseated whatever or if it is something the nurse cannot handle, then it is fine. But calling someone in the middle of the night to exact revenge is completely stupid, inappropriate, and immature.

I don't do it, and it's not MY profession - I'm not a nurse. I'm simply telling you what happens in some places.

And while you may think it's "completely stupid, inappropriate, and immature", calling nurses "stupid and lazy" as powermd did in his earlier posts in this thread could also be considered "completely stupid, inappropriate, and immature" as well. Respect is a two-way street, and it's earned, not bestowed along with the degree.

 

[sones]

I don't do it, and it's not MY profession - I'm not a nurse. I'm simply telling you what happens in some places.

And while you may think it's "completely stupid, inappropriate, and immature", calling nurses "stupid and lazy" as powermd did in his earlier posts in this thread could also be considered "completely stupid, inappropriate, and immature" as well. Respect is a two-way street, and it's earned, not bestowed along with the degree.

Well I AM a nurse...I also agree it is stupid, immature, and inappropriate for nurses to call the doc in the middle of the night because they don't like them. JWK you're absolutely correct that it does happen....for your information I have never done it. It's also stupid for the doc to ream out the nurse who calls at 3 am because their patient is bleeding profusely through their chest tube and their platelets are down to 30,000. This has happened. And thank you for the respect statement JWK....how can I respect someone who states my co-workers and myself are STUPID or DUMB.

 

[endodoc]

Well I AM a nurse...I also agree it is stupid, immature, and inappropriate for nurses to call the doc in the middle of the night because they don't like them. JWK you're absolutely correct that it does happen....for your information I have never done it. It's also stupid for the doc to ream out the nurse who calls at 3 am because their patient is bleeding profusely through their chest tube and their platelets are down to 30,000. This has happened. And thank you for the respect statement JWK....how can I respect someone who states my co-workers and myself are STUPID or DUMB.

I don't think he mean your profession as a whole are "stupid and dumb." What I believe he was say is, that there are a fair amount a those people in your field. When you look at this subject, you must be subjective and see it as a whole, rather than people like yourself that are professional.
As MD's we deal with your profession and well as you deal with our profession. I am sure you can say, there are some "dumb and stupid" MD's, as well as "dumb and stupid nurses."

I hope I am not off base here, but I am trying to be subjective on this topic.

 

[nchhabra]

I don't do it, and it's not MY profession - I'm not a nurse. I'm simply telling you what happens in some places.

And while you may think it's "completely stupid, inappropriate, and immature", calling nurses "stupid and lazy" as powermd did in his earlier posts in this thread could also be considered "completely stupid, inappropriate, and immature" as well. Respect is a two-way street, and it's earned, not bestowed along with the degree.

Sorry, it sounded like from the original post, that you were a nurse. No offense intended.

But I don't think it is an arguement of opinion. Its a pretty clear cut fact that it is inappropriate, immature, and stupid. That kind of behavior should not be tolerated, nor do I think it is for the most part. I can't speak for what powermd said in his posts and what he said is really irrelevant to what I said. I am not arguing with what he or you said, just stating that calling a doctor in the middle of the night to exact revenge is unacceptable. I have nowhere in my 1 post in this thread, shown any disrespect for nurses.

 

[powermd]

Sorry, it sounded like from the original post, that you were a nurse. No offense intended.

But I don't think it is an arguement of opinion. Its a pretty clear cut fact that it is inappropriate, immature, and stupid. That kind of behavior should not be tolerated, nor do I think it is for the most part. I can't speak for what powermd said in his posts and what he said is really irrelevant to what I said. I am not arguing with what he or you said, just stating that calling a doctor in the middle of the night to exact revenge is unacceptable. I have nowhere in my 1 post in this thread, shown any disrespect for nurses.

I certainly did not intend to indicate categorical disrespect for any group of health care providers. Just complete disrespect for the nurses who I have worked with who don't do their jobs well (missing important lab draws.. very common, supposedly missing IVs, asking me to do it, then backing down when I ask them which arm they stuck 5 times), and those who page me repeatedly for minor issues that, if they could think for themselves, wouldn't be worth a page (the patient's BP is 160/80.. in an asymptomatic patient who's baseline is...160/80!), or to exact revenge for some crime I apparently committed by asking for vitals and an ECG in a patient complaining of chest pain. I also lack any respect whatsoever for mid-levels who think med school is irrelevant because they met a few doctors who did things they didn't understand.

Just another anecdote- I was recently asked to help a fellow intern with a minor procedure because she wasn't yet certified to do it (we have a certification process for procedures as minor as venous blood draws and IV placement). As I was getting the equipment together, a critical care nurse, off her own floor, asked if I could do this procedure because she didn't trust my intern. I informed her that I was an intern as well, and that I would let her try. And if she didn't get it, I would get it. And if I didn't get it, my resident would. Yada yada yada. I didn't talk back to this nurse, but I was very offended by her attitude. This is a teaching hospital, and this was a relatively non-critical procedure. Sheesh. Where do they get that attitude? She came to me with it, I hadn't said a word to her. I didn't even know who she was.

 

[sones]

I certainly did not intend to indicate categorical disrespect for any group of health care providers. Just complete disrespect for the nurses who I have worked with who don't do their jobs well (missing important lab draws.. very common, supposedly missing IVs, asking me to do it, then backing down when I ask them which arm they stuck 5 times), and those who page me repeatedly for minor issues that, if they could think for themselves, wouldn't be worth a page (the patient's BP is 160/80.. in an asymptomatic patient who's baseline is...160/80!), or to exact revenge for some crime I apparently committed by asking for vitals and an ECG in a patient complaining of chest pain. I also lack any respect whatsoever for mid-levels who think med school is irrelevant because they met a few doctors who did things they didn't understand.
I'm sorry you work with such disagreeable people. i think if you ever practice privately you will find the nurses are much more agreeable and dependable. We even have fun sometimes!!! As for midlevel providers...i think there are definitely some out there that really have a "head to big for their britches"so to speak. There are a great deal more who are competent midlevel providers who just want some respect for what they have accomplished in return for respecting you for what you have accomplished. Many, myself included, went into midlevel provider professions because they did not want the responsibility or time requirement to become physicians. I want kids before I'm 35 and don't want to have them while I'm trying to work 80-100 hour weeks. If midlevel providers and physicians could just have a little respect for each other and work together we might see eye to eye a little better and patients might get better care.

 

[powermd]

I certainly did not intend to indicate categorical disrespect for any group of health care providers. Just complete disrespect for the nurses who I have worked with who don't do their jobs well (missing important lab draws.. very common, supposedly missing IVs, asking me to do it, then backing down when I ask them which arm they stuck 5 times), and those who page me repeatedly for minor issues that, if they could think for themselves, wouldn't be worth a page (the patient's BP is 160/80.. in an asymptomatic patient who's baseline is...160/80!), or to exact revenge for some crime I apparently committed by asking for vitals and an ECG in a patient complaining of chest pain. I also lack any respect whatsoever for mid-levels who think med school is irrelevant because they met a few doctors who did things they didn't understand.
I'm sorry you work with such disagreeable people. i think if you ever practice privately you will find the nurses are much more agreeable and dependable. We even have fun sometimes!!! As for midlevel providers...i think there are definitely some out there that really have a "head to big for their britches"so to speak. There are a great deal more who are competent midlevel providers who just want some respect for what they have accomplished in return for respecting you for what you have accomplished. Many, myself included, went into midlevel provider professions because they did not want the responsibility or time requirement to become physicians. I want kids before I'm 35 and don't want to have them while I'm trying to work 80-100 hour weeks. If midlevel providers and physicians could just have a little respect for each other and work together we might see eye to eye a little better and patients might get better care.

I think we agree on our fundamental positions, but I am still bothered by the semantics. Let's agree it's not just a willingness to work 80-100 hours per week and have additional legal responsibility that separates mid-levels from physicians. When you stated that here and in prior post(s), it sounded like you meant that was the ONLY difference and if only mid-levels would work longer hours and accept more responsibility, they would be equal to physicians, despite not going to medical school or doing a physician's residency. Please acknowledge that physicians do, in fact, bring more to the table than mid-levels with respect to the diagnosis and treatment of disease. Let's also agree that respect is NOT a two way street. Respect must be earned on both sides. Just because someone respects me for being a professional, and doing a good job does not automatically grant them my respect for their professinalism, or the quality of their work. What if they suck at what they do? That respect has to be earned on both sides. Now, if you're talking about simply respecting them as a fellow human being, and not treating them like dirt, well of course that works both ways.