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- Jan 15, 2008
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Me, for one.
Me, for one.
Crap, the nurses don't think I'm a tool.
There goes the rep.
Tired is well respected, if occasionally inflammatory.
I think the argument here stems from different definitions of the word watch.
Based on the posts in this thread, i'll go with inflammatory at best. Respect is earned, and his obvious disdain as well as ignorance of the role of the anesthesia provider taking care of his patients won't buy him any.
Crap, the nurses don't think I'm a tool.
There goes the rep.
i didn't read over the message. that's why. why can't you get experience from NICU and PICU? I know it's pediatric but I thought they were more difficult to handle than general care.
I would personally always recommend a CRNA rather than AA. Even though it states that they only require 1 year of critical care experience that is almost never enough to get in. Most people that get in have 3-6 years of quality ICU experience. The thing that concerns me is that it appears that people dont realize what some ICU nurses do. As an Open heart nurse in a hospital without residents or intesivists I get a post open-heat patient straight out of OR. Anesthesia leaves within minutes and more than half the time the patients are severely unstable-many are elderly with comorbidities. When the patient becomes unstable I do not like a good nurse go and call the surgeon first, since the patient would die while I connect but i do start multiple vasoactive drips, look at the xray and analyze hemodynamics and then I call to decide where we go from there. When the patient is stable I start to wean them off the vent by changing rates and modes and analyzing their response to the wean. When they are ready on CPAP and have good parametars me and the RT agree and extubate(no MD in sight.)Then in AM if everything is good I pull the Swan and A-line. This is perfect scenario but most often they are on IABP and R/LVAD and I do run these myself without a tech or MD. The experience I described is not extreme for a CRNA student but it could be said to be the norm.
Ok-so in some hospitals the RN's have more input from residents and attendings and I would looove to have an MD arround because the breadth of their education is enourmous and impressive. However-DO NOT think that spending few years in a unit like mine is nothing and does not ammount to a better Anesthesia provider.
Now, that I am in CRNA school I am humbled by the kowledge of the MDA and have no interest in ever competing for their role. As a mother I am not interested in working 80 hors a week or even raking 300K plus.Lastly I resent the comparison of NP and CRNA. CRNA's have been arround for 100+ years and have a track record of safety. NP is a fairly new role with sub-par education to say the least. It is a shame that NP curriculum send unprepared nurses to figure it out on the job. MY CRNA education consitsts of 1/2 year didactics and 2 years of pure clinical (50+ hours a week) and not some fluff classes.
I appologize for the long post and I might get flamed but it is a forum to express personal opinions. Good to be here🙂
While I appreciate your input, to this thread, I do have some qualms with your stance. Please know that I'm not trying to flame you.
I, too, spent several years in a very busy CVICU (although as an RT, obviously). While the nurses did a lot of what you say you do, it was all based off of a strict protocol. There wasn't a whole lot of critical thinking going on. Problem A got intervention 3.2... that kind of thing.
Please keep in mind that I'm really not trying to down play the role of nursing in ICU care, by the way... I'm REALLY not. However... you know as much as I do that there are many different levels of skills/drive/etc in nursing. Some of your fellow nurses, who might not be as driven/smart/etc as you are also getting into CRNA programs. They could be practicing independently at some point. You have to know somebody (either from your job who went to CRNA school, or current class) who you would not allow to provide anesthesia care for any of your family.
I do have a problem with your blanket statement of "I would personally always recommend a CRNA rather than AA." How can you honestly make this statement? I will give you one example that I think will force you to reconsider what you said:
I thought long and hard about AA school before deciding to go to medical school. I considered myself a rather driven RT, and thought that I had a fairly good level of smarts (please don't take this as me "tooting my own horn"... I'm really not full of myself. honest. 🙂). I had 5 years of critical care exposure as an RT, as well as learning TONS from our awesome nurses/residents/med students/attendings. I hold the belief that I would have made a pretty good AA. I decided to go to medical school instead.
On the flip side of this, I know a few CRNAs that haven't been able to explain some very simple phys/path. They had no idea about some basic lung phys/ventilator dynamics (like what SIMV was, etc..). Most of these CRNAs had been practicing for years... perhaps before the masters requirement. Please realize that I'm not trying to say that this is always the case... I know that one can find examples of poor providers of every type. I'm not trying to use this example to say that all CRNAs are bad and all AAs are good.
My point is this: In this specific case, who would you recommend to be the anesthesia provider for your child? Would you rather have an AA who is very driven, fairly smart, has years of clinical experience.... or would you rather have a CRNA who scraped by in classes, might only have a certificate level of education, and doesn't really care about his/her job?
Please broaden your mind. You don't know what everybody has gone through in life. You don't know what their individual experiences are. You might want to be a bit angry at the AANA with all of the *questionable* CRNA programs that they are starting up. They are effectively diluting the quality of providers, just to get more numbers. As some of the more outspoken posters on this board like to say - "don't drink the AANA kool-aid". Try and have some conversations with various providers before you really pass judgement on them. I know that many CRNAs are considered to be "ahead" of many AA students due to their clinical experience, however AA programs are well documented to include many more clinical hours. Even right out of school, one might be able to make an argument that the CRNA might be a bit ahead of the curve... but I'm pretty sure that most (who work with both providers) can agree that the difference levels out very quickly.
The endpoint is this: They are both proven to be safe providers in an ACT environment... with that being said, the AA will always be functioning in an ACT practice... the CRNA might not... even the CRNA who barely passed their classes/tests.
I would personally always recommend a CRNA rather than AA. Even though it states that they only require 1 year of critical care experience that is almost never enough to get in. Most people that get in have 3-6 years of quality ICU experience. The thing that concerns me is that it appears that people dont realize what some ICU nurses do. As an Open heart nurse in a hospital without residents or intesivists I get a post open-heat patient straight out of OR. Anesthesia leaves within minutes and more than half the time the patients are severely unstable-many are elderly with comorbidities. When the patient becomes unstable I do not like a good nurse go and call the surgeon first, since the patient would die while I connect but i do start multiple vasoactive drips, look at the xray and analyze hemodynamics and then I call to decide where we go from there. When the patient is stable I start to wean them off the vent by changing rates and modes and analyzing their response to the wean. When they are ready on CPAP and have good parametars me and the RT agree and extubate(no MD in sight.)Then in AM if everything is good I pull the Swan and A-line. This is perfect scenario but most often they are on IABP and R/LVAD and I do run these myself without a tech or MD. The experience I described is not extreme for a CRNA student but it could be said to be the norm.
Ok-so in some hospitals the RN's have more input from residents and attendings and I would looove to have an MD arround because the breadth of their education is enourmous and impressive. However-DO NOT think that spending few years in a unit like mine is nothing and does not ammount to a better Anesthesia provider.
Now, that I am in CRNA school I am humbled by the kowledge of the MDA and have no interest in ever competing for their role. As a mother I am not interested in working 80 hors a week or even raking 300K plus.Lastly I resent the comparison of NP and CRNA. CRNA's have been arround for 100+ years and have a track record of safety. NP is a fairly new role with sub-par education to say the least. It is a shame that NP curriculum send unprepared nurses to figure it out on the job. MY CRNA education consitsts of 1/2 year didactics and 2 years of pure clinical (50+ hours a week) and not some fluff classes.
I appologize for the long post and I might get flamed but it is a forum to express personal opinions. Good to be here🙂
Ok, I agree-I should not make blanket statements and it is probably true that after several years in practice they might be on the same level. The only thing that I have a real issue is that anyone would even begin to believe that there is not a lot of critical thinking in CVICU. Especially durng night shift. Do you think that we call the MD/Surgeon for anything at 3 AM, unless we really cant solve it ourselves. Protocols exist for everyone-an ER MD was gong crazy lookin for CaCh blocker overdose protocol. In my unit I assure you we do not work like little robots staring at the protocol-we already know what needs to be done. I just feel nurses get disrespected quite a bit and some of it is earned. There is a great differences in skills and knowledge/education between nurses and that needs to be addressed.
And yes you are right-I am kind of upset that all of these CRNA schools are popping left/right admiting people who have the minimum requirements. Bad for the proffession.
NP is a fairly new role with sub-par education to say the least. It is a shame that NP curriculum send unprepared nurses to figure it out on the job. MY CRNA education consitsts of 1/2 year didactics and 2 years of pure clinical (50+ hours a week) and not some fluff classes.
A bit off topic, but it doesn't much matter to me regarding significant differences. I want a physician passing my gas.
Plan ahead - there are a LOT of hospitals where it simply isn't done that way, even if there are anesthesiologists on staff.
A bit off topic, but it doesn't much matter to me regarding significant differences. I want a physician passing my gas.
No. That is why some people find the AA profession more appealing than the CRNA profession.
AA requires a year of: biology, chemistry, organic chemistry, anatomy, physiology, calculus, English and a semester of biochem and the MCAT and an undergraduate degree. You can then enter straight into a masters program.
CRNA requires you to work 2 years in critical care as an RN first.
Depending on where you are in life and what your long term goals are, each has its own pluses and minuses.
I personally wasn't sure what I wanted to do right away so I haven't taken all those science prerequisites. If I were to ever take them and the MCAT, I'd just go to medical school personally. I am going to graduate with a degree in psychology, enter an 11 month accelerated BSN program, and then work for 2 years while gaining experience, paying off undergraduate loans, and hopefully making some money to pay for my MSN program.
I also like the nursing option because if I ever decide I no longer want to work in anesthesia, I can do a post masters program and then work as a nurse practitioner or still use my RN license. If all you have is a Masters in AA, you are sorta stuck unless you do a whole different program, although I suppose you could always go to medical school. I'd also assume someone who take all those classes would have a science degree and could enter a Ph.D program or something.
So, in my opinion, it all depends on where you are in life and what your long terms goals are as to which program is better for you. For me, i think the CRNA program sounds much better.
Not to mention the fact that a CRNA can work under any doctor, legally, and can practice in all 50 states. An AA can only work under an Anesthesiologist MD/DO and is currently only legal to practice in a few states although that will obviously change.