Mindy325

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I have nothing against nurses, but I don't understand what some CRNAs are thinking. You would think that being nurses, they would be able to understand how we feel when our profession is threatened.

I recall a few years ago, some PACU nurses had to work with people who came in to help with a few tasks since they were short staffed. I'm not sure what their titles were. The nurses started wearing buttons urging patients to "Ask for an RN."

Now in the OR where you have OR techs who can scrub and do what only nurses used to do, the nurses still reserve some things that only they can do like circulate etc. Nurses are very protective of their turf. Why don't they understand if we are protective of ours?

How would CRNAs feel if a regular RN had been observing what the CRNA was doing long enough to feel that he or she could do the same job without the additional training? The regular RN could then take some portion of whatever test CRNAs take and pass it. They could then work for even cheaper and push the CRNAs out.

Would that sit well with CRNAs since some of them see nothing wrong with doing the same to us?
 

Taurus

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Agreed. CRNA's and nurses in general aren't the smartest group of people out there.

The CRNA backlash has already begun. In response to CRNA's push for autonomy, anesthesiologists are supporting AA's and being careful how they train SNRA's. Long-term, both are very bad for the future of CRNA's. CRNA's had it pretty good for a while but a few militant of them became greedy and wanted more. I think most CRNA's will regret what a few have done to their profession.

Once more anesthesia automation enters the OR, I think the point of autonomy will be less and less important because the team model will prevail in that setting.

Ethicon Endo-Surgery Urges FDA to Grant SEDASYS® System Appeal
 

Monty Python

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.... I recall a few years ago, some PACU nurses had to work with people who came in to help with a few tasks since they were short staffed. I'm not sure what their titles were. The nurses started wearing buttons urging patients to "Ask for an RN."

...... the nurses still reserve some things that only they can do like circulate etc. Nurses are very protective of their turf. Why don't they understand if we are protective of ours?

How would CRNAs feel if a regular RN had been observing what the CRNA was doing long enough to feel that he or she could do the same job without the additional training? The regular RN could then take some portion of whatever test CRNAs take and pass it. They could then work for even cheaper and push the CRNAs out......

Much of what you reflect on is strictly regulated by state law.
 

core0

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Much of what you reflect on is strictly regulated by state law.
But its completely a guild system. The Army has been using techs to circulate for years without a problem. However, try that in a civilian hospital and you would think the world had come to an end. Only a nurse can circulate because its obviously so much better to have a brand new nurse just out of school circulating than a tech who has done the case 100 times. Because one has a license and one doesn't. Nursing law is all about preserving the guild and increasing the salaries.
 

Mman

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But its completely a guild system. The Army has been using techs to circulate for years without a problem. However, try that in a civilian hospital and you would think the world had come to an end. Only a nurse can circulate because its obviously so much better to have a brand new nurse just out of school circulating than a tech who has done the case 100 times. Because one has a license and one doesn't. Nursing law is all about preserving the guild and increasing the salaries.
OK, I'll ask the question that others must be thinking.

(I'm not looking to bash circulating RNs)

What exactly do they do that requires a nursing license? In my hospital, they basically help set up a room and open stuff throughout the case and keep the count with the scrub rn/tech. They don't administer meds. They don't start IVs. They don't chart vitals. They don't call report. They ask a few basic questions of each patient (name, birthday, allergies, procedure, etc) and double check the consent and lead the timeout and then open sterile supplies throughout the case. I'm pretty sure that 99% of the thinking they do throughout the day was not covered in nursing school.
 

Monty Python

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But its completely a guild system. The Army has been using techs to circulate for years without a problem. However, try that in a civilian hospital and you would think the world had come to an end. Only a nurse can circulate because its obviously so much better to have a brand new nurse just out of school circulating than a tech who has done the case 100 times. Because one has a license and one doesn't. Nursing law is all about preserving the guild and increasing the salaries.

I work at a military hospital as a civilian employee of the government. Circulating is an RN-only function even at this military hospital, and in every other military hospital I've worked in as a civilian and as a reservist (N > 25 since 1992). In addition I still participate in the military reserves. My overseas deployment came with RNs-only to circulate in the FRSS. The only times techs would conceivably circulate is when the shizzat is truly hitting the fan.

Do you suggest removing all guild laws, and letting the free market work unfettered? Would you want the the graduate of last night's Sally Struthers home-study infomercial in the OR? You would also potentially run afoul of all those alphabet soup accreditating agencies for using unlicensed personnel for certain specific functions.

A circulating tech cannot access the central core Omnicell for me if I need more xxx, only a licensed professional may.
 

periopdoc

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What exactly do they do that requires a nursing license?
I don't know if it is the same everywhere, but at the places where I have worked the circulator is responsible for getting any additional pharmaceuticals that I need during the operation. This can't require a license because pharmacy techs do the same thing when I go to the pharmacy window to get stuff. However, I would assume that this is not part of the scope of the OR tech certification.

- pod
 

Mman

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I don't know if it is the same everywhere, but at the places where I have worked the circulator is responsible for getting any additional pharmaceuticals that I need during the operation. This can't require a license because pharmacy techs do the same thing when I go to the pharmacy window to get stuff. However, I would assume that this is not part of the scope of the OR tech certification.

- pod
Our anesthesia techs get extra drugs from the pharmacy for us during the case.
 

periopdoc

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Ronin2258

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Our anesthesia techs get extra drugs from the pharmacy for us during the case.
Sounds different than when I was a OR tech. I could receive local anesthetics, antibiotics, etc. But the schedule II stuff was definitely no-can-touch unless you were a nurse or a physician.
 
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Mindy325

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I have opened countless sterile packages, and tied many surgeons' gowns when the circulator was out of the room. But if heaven forbid I have to step out to the PYXIS machine for more meds, some circulators will run out of the room to get me. Why? Because the surgeon wants the bed elevated or lowered or whatever, so it's .hard to believe that in some places the circulators are getting anesthesia meds. In my place they don't have or even want access to the PYXIS machine. That way they won't be asked to come witness our medication waste in the machine. The exception would be the endo nurses.

Edited to discuss font change. Hmm! For some reason the font of the message changed and the change was not evident in the message preview window.
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core0

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I work at a military hospital as a civilian employee of the government. Circulating is an RN-only function even at this military hospital, and in every other military hospital I've worked in as a civilian and as a reservist (N > 25 since 1992). In addition I still participate in the military reserves. My overseas deployment came with RNs-only to circulate in the FRSS. The only times techs would conceivably circulate is when the shizzat is truly hitting the fan.

Do you suggest removing all guild laws, and letting the free market work unfettered? Would you want the the graduate of last night's Sally Struthers home-study infomercial in the OR? You would also potentially run afoul of all those alphabet soup accreditating agencies for using unlicensed personnel for certain specific functions.

A circulating tech cannot access the central core Omnicell for me if I need more xxx, only a licensed professional may.
My experience predates yours by a few years and I have no idea what the military is doing now. However, in the mid 80's we ran four rooms with 8 techs and one RN to get meds (that was the only thing that needed an RN license). Even now there is no reason that a non-physician cannot access the core under a physicians orders. in the real world you would be suprised whats done without an RN license. IVs are started and meds administered all the time in physician offices under delegated physician practice.

My point is not to get rid of the guild system. Its to point out how duplicitious nursing is with it. They can go on and on about the origins of "doctor" and how it doesn't only mean physicians in a medical context. However, use the word nurse by anyone that doesn't have RN behind their name and listen to the howls. Never mind the origin of the word predated any type of clinical or didactic program. If we are going to use "doctor" in the context of medicine for anyone who received any kind of doctoral degree from any source, why not open up the term nurse to anyone who provides care. Make the CNAs, EMT.s etc all nurses. Or ask the basic question. Of the jobs done by nurses which one of them need to be done by a nurse. Maybe there is a better model where we use lots of cheaper LPNs and CNAs with a few nurses to supervise things. Or maybe we find out that that we don't really need nurses at all.

If nursing wants to claim the ability to practice medicine under the guise of nursing or wants independence then turnabout is fair play. Open up nursing to anyone that wants to do it and see what happens.
 

GasEmDee

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My point is not to get rid of the guild system. Its to point out how duplicitious nursing is with it. They can go on and on about the origins of "doctor" and how it doesn't only mean physicians in a medical context. However, use the word nurse by anyone that doesn't have RN behind their name and listen to the howls. Never mind the origin of the word predated any type of clinical or didactic program. If we are going to use "doctor" in the context of medicine for anyone who received any kind of doctoral degree from any source, why not open up the term nurse to anyone who provides care. Make the CNAs, EMT.s etc all nurses. Or ask the basic question. Of the jobs done by nurses which one of them need to be done by a nurse. Maybe there is a better model where we use lots of cheaper LPNs and CNAs with a few nurses to supervise things. Or maybe we find out that that we don't really need nurses at all.

If nursing wants to claim the ability to practice medicine under the guise of nursing or wants independence then turnabout is fair play. Open up nursing to anyone that wants to do it and see what happens.

I agree wholeheartedly. I cannot stand the hypocrisy. Go to nurse-anesthesia.org, and you will hear things like:

1) how upset nurses get when medical assistants (MAs) behave in a manner that misleads the patient to believe these MAs are actually RNs.

2) how CRNAs have a more intense, arduous education than NPs and AAs

And in the same breath, they will decry anesthesiologists who use similar arguments with respect to CRNAs as pompous and arrogant.

One senior CRNA over there put down an AA (JWK), saying that the AA profession is merely a "consolation prize" for those who could not get into medical school or another professional school. I thought that really ironic, since I don't recall any of my friends and colleagues -- many who were high school valedictorians and who went to the IVY league -- talking about any lifelong dream to become a CRNA.

Oh yeah, and did you know that I had to do an internship after medical school specifically so that I could learn everything a nurse already knows? Learned that on nurse-anesthesia.org recently, too.

If you look at my post history on SDN, I have -- until recently -- said nothing about this whole CRNA vs Anesthesiologist thing. Lately though, I have become galvanized over the matter, specifically because of the hypocrisy and falsehoods those guys over at nurse-anesthesia.org will spew.
 
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Year one of medical school, the biggest lesson I learned was exactly how wrong I was about becoming a physician. It wasn't until after that first semester that I truly realized how much there was to know, and how much we were expected to know.

This is a lesson you cannot comprehend, period, until you go through the courses.

Medical school also teaches you to respect the different domains of knowledge that individuals have. I am going into anesthesia, and understand that I am never going to give advice to friends/neighbors about their rash, because even my 4 years of med-school and next year as an intern, I will STILL NOT POSSESS the appropriate training to do so.
 

GasEmDee

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Year one of medical school, the biggest lesson I learned was exactly how wrong I was about becoming a physician. It wasn't until after that first semester that I truly realized how much there was to know, and how much we were expected to know.

This is a lesson you cannot comprehend, period, until you go through the courses.

Medical school also teaches you to respect the different domains of knowledge that individuals have. I am going into anesthesia, and understand that I am never going to give advice to friends/neighbors about their rash, because even my 4 years of med-school and next year as an intern, I will STILL NOT POSSESS the appropriate training to do so.
I agree with you. I would go even a little further: it is not until after at least internship, or even residency -- when you are making independent decisions -- that you truly realize how much you do not know.

A large part of clinical acumen is to be able to operate in the setting of incomplete information. That is, you have to define what is known, what is not known, and what is knowable, but not known to you. Then you have to render a decision despite the uncertainties and your own personal ignorance.


You do not develop this by following someone else's orders. You develop it by making independent decisions, and bearing the consequences of (i.e., responsibility for) those decisions.
 
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I obviously cannot comment on decisions after residency, but I agree completely when i extrapolate my experiences forward.

Each step, there is a new appreciation that I gain for what goes into a decision. I have a sibling who is 2 years behind me in medical school, and despite very similar mental capabilities, the thought process and decision making in conversation is completely different between the two of us.

I think the physician training is the only one which teaches you this reality, and allows continued growth as you move forward through a career.