CRNA Training/competency

[BLADEMDA]

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I have a friend who has SRNAs rotate through his hospital. The SRNAs are from a respected state school university. Yet, these SRNAs get inadequate clinical training for the most part and have reduced/strict hours per week. He tells me they are capped at 40 hours a week as a junior student with most getting around 30 hrs. The junior year has little clinical time.

As a senior SRNA their hours are capped again at 40 hrs then go up to 45 the last 8-9 months. I'm Told the actual clinical time is about 12-14 months with an average work week of 40 hrs.

Few of these SRNAs will stay over to do any extra work. Even fewer will put in any extra effort to seek out input. Most want to graduate with the minimum and just be a CRNA.
Then, after they are on someone's payroll they want to learn new blocks and skills.

From what I'm told the AANA concept of "equal to an MD Anesthesiologist" is simply a bold. faced lie. But, like most propaganda if you say something often enough and loud enough then the public will believe it.

 

[BLADEMDA]

This isn't a thread about CRNA bashing but rather to expose the inadequacy of SRNA training especially in my state for independent practice. SRNAs on average barely receive an adequate education to work In a strict ACT practice; few can work with minimal supervision and even fewer have the skills to practice Independently even at a surgicenter.

The good news is that I'm told the average SRNA at these schools isn't nearly as good as the SRNAs from ten years ago. This means the AANA is producing a lot of marginal CRNAs and few good ones.
I view this as a major positive trend for Anesthesiologist job security. The over abundance of marginal CRNAs is also pushing down wages for the first time ever.

The bad news is that the oversupply of marginal CRNAs means you must supervise them that Much closer and actually train the new graduate for about a year to function in the ACT. In addition, the oversupply of new CRNAs means more AMCs, hospitals and groups will replace Anesthesiologists with these $110K per year providers.

The AA has nothing to fear clinically from SRNAs; it is all political theater by the AANA

 

[WholeLottaGame7]

This isn't a thread about CRNA bashing but rather to expose the inadequacy of SRNA training especially in my state for independent practice. SRNAs on average barely receive an adequate education to work In a strict ACT practice; few can work with minimal supervision and even fewer have the skills to practice Independently even at a surgicenter.

The good news is that I'm told the average SRNA at these schools isn't nearly as good as the SRNAs from ten years ago. This means the AANA is producing a lot of marginal CRNAs and few good ones.
I view this as a major positive trend for Anesthesiologist job security. The over abundance of marginal CRNAs is also pushing down wages for the first time ever.

The bad news is that the oversupply of marginal CRNAs means you must supervise them that Much closer and actually train the new graduate for about a year to function in the ACT. In addition, the oversupply of new CRNAs means more AMCs, hospitals and groups will replace Anesthesiologists with these $110K per year providers.

The AA has nothing to fear clinically from SRNAs; it is all political theater by the AANA

That's what happens when CRNA schools are for-profit: the motivation is to make money, not maximize quality of training.

Unlike some posters, I don't think large quantities of undertrained CRNAs are a threat to the field; only to the patients.

While in rough economic time we tend to go for value, America as a whole is narcissistic and wants the best of everything: there's a reason people don't flock to WNBA games (or why we'll watch the World Cup but not MLS).

 

[periopdoc]

Oh well, what can be done? Who is John Galt?

-pod

 

[deleted126335]

Oh well, what can be done? Who is John Galt?

-pod

The response to threat of John Galt leaving will be, "don't let the door hit you in the ass on the way out Mr. Galt. Plenty of your fellow anesthesiologists will stay and be slaves to the lifestyle or the debt".

 

[periopdoc]

But you misinterpret the supposition in my post. Was it not the individual who stayed behind, devoid of ability, desire, and willingness to effect change, who was left to ask the question, "Who is John Galt?"

These fellow slaves are they of whom I speak.

-pod

 

[BLADEMDA]

Are any of you aware of the AANA minimum requirements to become a CRNA? Really. Have you seen the required cases/procedures?

It is quite possible a CA 1 resident at the end of his/her year could meet these requirements. This means some CRNAs have no more clinical training than a CA2 resident in July of the start of that year. Combine those minimal requirements without a medical school degree along with lower intellectual skills (on average) and you have a setup for disaster

That type of provider should never be allowed to practice independently.

 

[pd4emergence]

Blade,
You are absolutely correct. The minimum requirements set by the aana are woefully inadequate. Somebody more technically savvy than I will probably post them on this thread. The fact is very few have the skill set right out of school go to a place where they function independently. Most know this and go to a place where they are supervised for a few years to gain some experience if they plan on not being supervised.

 

[pgg]

While in rough economic time we tend to go for value, America as a whole is narcissistic and wants the best of everything: there's a reason people don't flock to WNBA games (or why we'll watch the World Cup but not MLS).

How on earth does anyone tolerate watching college football then?

 

[Notanerd]

Hate to be political but i really compare the AANA to the left wing political groups in this country. They have a large base that just really lobby's well ,are both based on garbage media coverage not looking at true credentials/facts/training, want something for nothing, and to be treated as equals with out going through earning the credentials to do so. Also the representation of the AANA is loud and speaks garbage like reid/pelosi/sebelius. Not putting any more effort into making this comparison but they are just so similar. Both ruining something great.

 

[WholeLottaGame7]

How on earth does anyone tolerate watching college football then?

Because I'm pretty sure the Alabamas of the world could easily knock off the Chiefs of the world. Plus there are geographical considerations, etc. It's not a perfect analogy but it's close enough.

 

[BLADEMDA]

Blade,
You are absolutely correct. The minimum requirements set by the aana are woefully inadequate. Somebody more technically savvy than I will probably post them on this thread. The fact is very few have the skill set right out of school go to a place where they function independently. Most know this and go to a place where they are supervised for a few years to gain some experience if they plan on not being supervised.

I challenge anyone to post the AANA requirements for SRNA graduation online. If the Training is ineed "equivalent" let's see those numbers. I know that many SRNAs graduate with little training in Regional or Central line placement. Few know how to do anything other than a basic intubation and get relieved exactly per their schedule.

These SRNAs are doing only 40 hours of clinical training per week (on average) for 1 year.
That's it. In addition, the acuity of the cases are far lower compared to a Residency program. Clearly, the propaganda of the AANA machine doesn't match the facts on the ground.

The scary part about all this watered down training, clocking out early, reduced clinical time, weaker SRNA students, etc. is that they are the next generation of stool sitters for this nation. Hence, not only are these new graduates unfit for Independent Practice many are unfit to work in an ACT.

 

[BLADEMDA]

http://home.coa.us.com/Documents/Revised Draft Practice Doctorate Standards-Oct 2012.pdf

Go to page 24. Please note these requirements are for the DOCTORATE level Degree (DNAP) and not the current degree (Master's). I assume the current requirements are lower and are the crossed off number in many cases.

CENTRAL VENOUS CATHETER PLACEMENT= 10. All of which can be simulated placement.

Ditto for Regional Nerve Blocks. Also, observing a nerve block while an Attending Anesthesiologist actually does the procedure counts in the requirements.

Whatever cases the SRNA doesn't have come graduation are simply "fudged" by the student and/or school in order to qualify that SRNA.
(But, if the SRNA were to exert any effort whatsoever the "fudging" wouldn't be necessary; however, a 40 hour work week precludes getting a proper clinical education when you only have 12 months of Clinical time.)

The COA/AANA doesn't care about quality, patient safety or SRNA education. It is all about the money and membership numbers.
The AANA has become the "Chinese" Anesthesia provider (in terms of quality) in the USA.

 

[BLADEMDA]

http://home.coa.us.com/Documents/Revised Draft Practice Doctorate Standards-Oct 2012.pdf

Go to page 24. Please note these requirements are for the DOCTORATE level Degree (DNAP) and not the current degree (Master's). I assume the current requirements are lower and are the crossed off number in many cases.

CENTRAL VENOUS CATHETER PLACEMENT= 10. All of which can be simulated placement.

Ditto for Regional Nerve Blocks. Also, observing a nerve block while an Attending Anesthesiologist actually does the procedure counts in the requirements.

Whatever cases the SRNA doesn't have come graduation are simply "fudged" by the student and/or school in order to qualify that SRNA.
(But, if the SRNA were to exert any effort whatsoever the "fudging" wouldn't be necessary; however, a 40 hour work week precludes getting a proper clinical education when you only have 12 months of Clinical time.)

The COA/AANA doesn't care about quality, patient safety or SRNA education. It is all about the money and membership numbers.
The AANA has become the "Chinese" Anesthesia provider (in terms of quality) in the USA.

The AA has no problems matching or exceeding the "weak" clinical education of many CRNA programs. An AA student dedicated to his/her profession who is willing to put the time and effort into clinical rotations will far exceed the majority of today's SRNAs in terms of clinical competence.

Unfortunately, in the USA it isn't about clinical competence or patient safety but PAC money/poltical influence and that the AANA has plenty of. Sadly, almost no effort is being made in improving the actual clinical education of the SRNA while the degree is upgraded from Masters to Doctorate level: Typical AANA smoke and mirrors.

 

[deansrv72]

Are any of you aware of the AANA minimum requirements to become a CRNA? Really. Have you seen the required cases/procedures?

It is quite possible a CA 1 resident at the end of his/her year could meet these requirements. This means some CRNAs have no more clinical training than a CA2 resident in July of the start of that year. Combine those minimal requirements without a medical school degree along with lower intellectual skills (on average) and you have a setup for disaster

That type of provider should never be allowed to practice independently.

the things that you point out in this thread are, unfortunately, all too real. the quality of providers has decreased, as a whole, dramatically over the last 4-5 years, that i'm aware of. and that is (and has been) occurring in several states across the country.

as to minimum requirements, it is the COA that sets minimum requirements that each anesthesia school must follow, not the AANA. and much resistance has been met with the COA when these things have been addressed. i'll even go so far as to say that some BOD/COA members have been told, by applicants, that admission requirements are/were too stringent.

 

[bala1]

Are any of you aware of the AANA minimum requirements to become a CRNA? Really. Have you seen the required cases/procedures?

It is quite possible a CA 1 resident at the end of his/her year could meet these requirements. This means some CRNAs have no more clinical training than a CA2 resident in July of the start of that year. Combine those minimal requirements without a medical school degree along with lower intellectual skills (on average) and you have a setup for disaster

That type of provider should never be allowed to practice independently.

No **** sherlock, but you are preaching to the choir here. Go find yourself a legislator and pound that into their heads over and over and over and over until they understand. Because now all they understand is "gas on gas off" whats the difference who flips the switch.

 

[pd4emergence]

I wonder if the observed decease in quality trained crna's is a indirect result of the aana's legislative efforts. It seems younger anesthesiologists, are more aware of the issues of crna's and their organization's efforts of independent practice including pain. Most of my colleagues that are my age take a pretty hard line when it comes to srna training. I work at an academic place. Before I signed on, I looked at my contract regarding this issue. Long story short, I am not obligated to teach them anything.

 

[BLADEMDA]

the things that you point out in this thread are, unfortunately, all too real. the quality of providers has decreased, as a whole, dramatically over the last 4-5 years, that i'm aware of. and that is (and has been) occurring in several states across the country.

as to minimum requirements, it is the COA that sets minimum requirements that each anesthesia school must follow, not the AANA. and much resistance has been met with the COA when these things have been addressed. i'll even go so far as to say that some BOD/COA members have been told, by applicants, that admission requirements are/were too stringent.

The reality is that the AANA is the parent organization of the COA. While the COA appears "independent" on paper the AANA controls the strings. When and if the AANA membership as a whole demands change the COA will bow to the pressure. The fact is many in leadership roles in the AANA like the increasing numbers of CRNAs/SRNAS as it means more money and power for the AANA. It is always about money, power and control for the AANA and NOT about producing quality providers.

 

[BLADEMDA]

http://home.coa.us.com/Pages/default.aspx



"From the practitioner's viewpoint, what value does the COA bring to the nurse anesthesia profession?" "As a practitioner, I have always believed that those who control the education control the profession..."


The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a CRNA Educator Director and a CRNA Practitioner Director. Candidates must be available to attend 3-day COA meetings, typically held in January, May and October. The term of office is for 3 years, beginning Fall 2013 through Fall 2016. The individual then would be eligible to be considered for reelection

 

[BLADEMDA]

COA Directors
Page Content

Back row left to right, Keith Torgersen, CRNA, MSN, CRNA Practitioner, Bette Wildgust, CRNA, MS, MSN, CRNA Educator, Maria D. Garcia-Otero, CRNA, PhD, CRNA Practitioner; James P. Singsank, CPA, MBA, Public Representative, Allyn Peterson, MS, RN, CNOR; Healthcare Administrator; Sass Elisha, CRNA, MSN, CRNA Educator, Christopher Reed, MSN RN, Student Representative, Judith Watkins, EdD, Public Representative

Front row left to right: Kay K. Sanders, CRNA, DNP, Vice Chair , Kathy Cook, CRNA, MS, Chair, Mary Marienau, CRNA, PhD, Secretary Treasurer, Frank Gerbasi, CRNA, PhD, Executive Director COA


http://home.coa.us.com/about/Pages/COA-Directors.aspx (picture of those above)

 

[BLADEMDA]

 

[BLADEMDA]

 

[periopdoc]

People like to shop at Wal Mart. Apparently they are ok with the Wal Martification of medicine and we are on the cutting edge of this one. There was nothing we could do about it. WIJG.

-pod

 

[pgg]

People like to shop at Wal Mart. Apparently they are ok with the Wal Martification of medicine and we are on the cutting edge of this one. There was nothing we could do about it. WIJG.

-pod

People who shop at WalMart know they're getting the low quality fruits of Chinese slave-labor, and they accept that because it's cheap. Everyone who really values individual freedom, self determination, and personal responsibility should be OK with that.

If the public was genuinely making a similar informed (even if passive) decision to accept anesthesia care from a CRNA instead of an anesthesiologist for a lower bill or shorter wait or 10% off coupon to an affiliated massage parlor, I'd be OK with that too. But they're being lied to by the AANA, and their choices are being manipulated and shrouded in misdirection by that cynical, self-serving organization ... and to top it all off, they're not even getting a discount on their bill.

 

[bala1]

People who shop at WalMart know they're getting the low quality fruits of Chinese slave-labor, and they accept that because it's cheap. Everyone who really values individual freedom, self determination, and personal responsibility should be OK with that.

If the public was genuinely making a similar informed (even if passive) decision to accept anesthesia care from a CRNA instead of an anesthesiologist for a lower bill or shorter wait or 10% off coupon to an affiliated massage parlor, I'd be OK with that too. But they're being lied to by the AANA, and their choices are being manipulated and shrouded in misdirection by that cynical, self-serving organization ... and to top it all off, they're not even getting a discount on their bill.

Insert medical instead of anesthesia.

Insert nurse, instead of CRNA.

They are getting medical care from a nurse without their consent! At least in opt out states.

Folks, the complication rate will increase. How can it not?

 

[Arch Guillotti]

Insert medical instead of anesthesia.

Insert nurse, instead of CRNA.

They are getting medical care from a nurse without their consent! At least in opt out states.

Folks, the complication rate will increase. How can it not?

Nurses work solo in non opt-out states also unfortunately. MAny silent assassins are out there.