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Me, for one.
CRNA vs. AA What's the diff?
- Thread starter Raydanation
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Second.
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Don't worry. I'm sure the crappy nurses still think you're a tool. 😛
D
deleted6669
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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.
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http://www.asahq.org/Newsletters/200...agen02-08.html
The question for decades: Do differences in the education and practice of anesthesiologist assistants (AA) and nurse anesthetists (NAs) indicate the superiority of one profession over the other in either ability or capability? AAs and NAs are both longstanding members of the anesthesia care team (ACT). ASA and the Centers for Medicare & Medicaid Services (CMS) share the position that AAs and NAs have identical clinical capabilities and responsibilities. Nearly four decades of experience have proven the safety of the ACT with either an NA or AA as the nonphysician anesthetist. However, certain differences do exist between AAs and NAs. Since some of these differences are being mischaracterized in claims of superiority of one over the other, objective investigation and documentation was called for and was assigned to the Committee on the Anesthesia Care Team (CACT). This article summarizes the findings.
After thoroughly analyzing prerequisites for admission, curricula, graduation and certification requirements, and clinical practice and overall quality, the CACT drafted the recently approved ASA Statement Comparing Anesthesiologist Assistant and Nurse Anesthetist Education and Practice (the complete statement can be found in the Members Only section of the ASA Web site). The committee was greatly aided in its mission by the coincidental publication of an impartial study comparing the education and practice of AAs and NAs commissioned by the Kentucky Legislature. The Legislative Research Commission published its 59-page detailed report on February 2007 (see http://www.asahq.org/Newsletters/200..._Report337.pdf). Of note, several other states (recently Florida and North Carolina) have reached the same conclusion.
Three differences between AAs and NAs can be summarized as follows:
1. Prerequisites to training: NA schools require an RN degree and one year of critical care work experience. AA schools require an undergraduate degree emphasizing the requirements for medical school admission. ASA agrees with the impartial findings of the Kentucky Legislature that the requirement for clinical experience may constitute a temporary aid to those beginning their NA or AA education, but it makes no difference to the final outcome of that training.
2. Performance of regional anesthesia and invasive catheters: More NA education programs provide instruction in the technical aspects of regional anesthesia. A higher percentage of AA programs provide instruction in the placement of invasive monitors. There is no evidence to suggest that the innate abilities of either student type impact their suitability for these anesthesia practices. The decision by some AA programs to limit the teaching of regional techniques was influenced by the opinion of some anesthesiologists that neither AAs nor NAs should perform these invasive procedures. That limitation is voluntary, consistent with ASA policy and was implemented to enhance patient safety.
3. Supervision and independent practice: AAs must be supervised by an anesthesiologist, and NAs may be supervised by any physician. Political victories rather than changes in education have allowed NAs in some states to practice without the CMS requirement for physician supervision. Requiring that anesthesiologists supervise AAs in no way constitutes a mark of inferiority. To the contrary, and as concluded by the Kentucky study, AA work is directed only by anesthesiologists because AAs want it that way. They agree that the safest ACT is one led by an anesthesiologist, so it is their desire to practice in a manner that supports what they agree is the highest quality and safety available.
History has everything to do with the differences above. The AA profession was founded in the early 1970s by anesthesiologists striving to design an improved educational program for anesthesia physician extenders that would also include a direct path to medical school if desired. Focused on that goal, those pioneers in education recognized the value added by strong premedical backgrounds. By requiring prerequisites for admission to medical school in order to qualify for admission to AA schools, AAs may go from AA practice directly into medical school. Disadvantaged in this regard, NAs who wish to advance their ability and knowledge in anesthesia by becoming anesthesiologists have to first go back to the undergraduate level to complete a premedical curriculum. Thus by history, tradition, philosophy of education and desire, the AA is trained to work within the ACT. The quality and scope of their education has nothing to do with this decision.
In distinction, the NA discipline developed much earlier, in the late 1800s and early 1900s, in response to surgeons requests for more anesthesia providers. As now, anesthesiologists alone could not accommodate all surgical demands. Necessity was truly the mother of invention for the evolution of NA practice we needed more anesthesia providers. As early as 1916, NAs began fighting legal battles claiming their right to provide anesthesia supervised only by surgeons. NA organizations have never formally supported or advocated for the idea that NA care is safer under the direction of an anesthesiologist or even supervision of a surgeon. Their legal right to practice without the supervision of an anesthesiologist is the result of their history, tradition, philosophy of education and tremendous political effort.
In summary, our analysis of prerequisites for admission, curricula, graduation and certification requirements, clinical practice, and overall quality and ability of both AAs and NAs supports the findings of the comprehensive, unbiased study of the Kentucky Legislature and CMS policies recognizing the two professions as being equivalent. After a year of practice, the relative quality and skill of individual AAs or NAs likely has more to do with personal talents and abilities than the educational route taken. This observation is supported by the testimonies of many anesthesiologists who have gained valuable insights working within the ACT for decades with both NAs and AAs who find no significant differences between the two groups of professionals in their daily clinical practices.
ASAs conclusion: Differences do exist between AAs and NAs in regard to the prerequisites, curriculum, instruction in regional anesthesia and invasive monitoring, and requirements for supervision in practice. However, these differences are not based on superiority of education or ability, but are rather a product of differences in historical development and the philosophies and motivations of those that practice within each profession.
Bibliography:
Steinhaus, et al. Analysis of manpower in anesthesiology. Anesthesiology. 1970; 33(3):350-356.
Groudine SB. Anesthesiologist assistants: Being a (care) team player. ASA Newsl. 2001; 65(3):16-17,29.
Gravenstein JS, Steinhaus JE. The origin of the anesthesiologist assistant. ASA Newsl. 2003: 67(3):5-6.
The Web site of the American Association of Anesthesiologist Assistants. www.anesthetist.org.
The Web site of the American Association of Nurse Anesthetists. www.aana.com.
FAQs about AAs. ASA Website. www.asahq.org/career/aa.htm.
The question for decades: Do differences in the education and practice of anesthesiologist assistants (AA) and nurse anesthetists (NAs) indicate the superiority of one profession over the other in either ability or capability? AAs and NAs are both longstanding members of the anesthesia care team (ACT). ASA and the Centers for Medicare & Medicaid Services (CMS) share the position that AAs and NAs have identical clinical capabilities and responsibilities. Nearly four decades of experience have proven the safety of the ACT with either an NA or AA as the nonphysician anesthetist. However, certain differences do exist between AAs and NAs. Since some of these differences are being mischaracterized in claims of superiority of one over the other, objective investigation and documentation was called for and was assigned to the Committee on the Anesthesia Care Team (CACT). This article summarizes the findings.
After thoroughly analyzing prerequisites for admission, curricula, graduation and certification requirements, and clinical practice and overall quality, the CACT drafted the recently approved ASA Statement Comparing Anesthesiologist Assistant and Nurse Anesthetist Education and Practice (the complete statement can be found in the Members Only section of the ASA Web site). The committee was greatly aided in its mission by the coincidental publication of an impartial study comparing the education and practice of AAs and NAs commissioned by the Kentucky Legislature. The Legislative Research Commission published its 59-page detailed report on February 2007 (see http://www.asahq.org/Newsletters/200..._Report337.pdf). Of note, several other states (recently Florida and North Carolina) have reached the same conclusion.
Three differences between AAs and NAs can be summarized as follows:
1. Prerequisites to training: NA schools require an RN degree and one year of critical care work experience. AA schools require an undergraduate degree emphasizing the requirements for medical school admission. ASA agrees with the impartial findings of the Kentucky Legislature that the requirement for clinical experience may constitute a temporary aid to those beginning their NA or AA education, but it makes no difference to the final outcome of that training.
2. Performance of regional anesthesia and invasive catheters: More NA education programs provide instruction in the technical aspects of regional anesthesia. A higher percentage of AA programs provide instruction in the placement of invasive monitors. There is no evidence to suggest that the innate abilities of either student type impact their suitability for these anesthesia practices. The decision by some AA programs to limit the teaching of regional techniques was influenced by the opinion of some anesthesiologists that neither AAs nor NAs should perform these invasive procedures. That limitation is voluntary, consistent with ASA policy and was implemented to enhance patient safety.
3. Supervision and independent practice: AAs must be supervised by an anesthesiologist, and NAs may be supervised by any physician. Political victories rather than changes in education have allowed NAs in some states to practice without the CMS requirement for physician supervision. Requiring that anesthesiologists supervise AAs in no way constitutes a mark of inferiority. To the contrary, and as concluded by the Kentucky study, AA work is directed only by anesthesiologists because AAs want it that way. They agree that the safest ACT is one led by an anesthesiologist, so it is their desire to practice in a manner that supports what they agree is the highest quality and safety available.
History has everything to do with the differences above. The AA profession was founded in the early 1970s by anesthesiologists striving to design an improved educational program for anesthesia physician extenders that would also include a direct path to medical school if desired. Focused on that goal, those pioneers in education recognized the value added by strong premedical backgrounds. By requiring prerequisites for admission to medical school in order to qualify for admission to AA schools, AAs may go from AA practice directly into medical school. Disadvantaged in this regard, NAs who wish to advance their ability and knowledge in anesthesia by becoming anesthesiologists have to first go back to the undergraduate level to complete a premedical curriculum. Thus by history, tradition, philosophy of education and desire, the AA is trained to work within the ACT. The quality and scope of their education has nothing to do with this decision.
In distinction, the NA discipline developed much earlier, in the late 1800s and early 1900s, in response to surgeons requests for more anesthesia providers. As now, anesthesiologists alone could not accommodate all surgical demands. Necessity was truly the mother of invention for the evolution of NA practice we needed more anesthesia providers. As early as 1916, NAs began fighting legal battles claiming their right to provide anesthesia supervised only by surgeons. NA organizations have never formally supported or advocated for the idea that NA care is safer under the direction of an anesthesiologist or even supervision of a surgeon. Their legal right to practice without the supervision of an anesthesiologist is the result of their history, tradition, philosophy of education and tremendous political effort.
In summary, our analysis of prerequisites for admission, curricula, graduation and certification requirements, clinical practice, and overall quality and ability of both AAs and NAs supports the findings of the comprehensive, unbiased study of the Kentucky Legislature and CMS policies recognizing the two professions as being equivalent. After a year of practice, the relative quality and skill of individual AAs or NAs likely has more to do with personal talents and abilities than the educational route taken. This observation is supported by the testimonies of many anesthesiologists who have gained valuable insights working within the ACT for decades with both NAs and AAs who find no significant differences between the two groups of professionals in their daily clinical practices.
ASAs conclusion: Differences do exist between AAs and NAs in regard to the prerequisites, curriculum, instruction in regional anesthesia and invasive monitoring, and requirements for supervision in practice. However, these differences are not based on superiority of education or ability, but are rather a product of differences in historical development and the philosophies and motivations of those that practice within each profession.
Bibliography:
Steinhaus, et al. Analysis of manpower in anesthesiology. Anesthesiology. 1970; 33(3):350-356.
Groudine SB. Anesthesiologist assistants: Being a (care) team player. ASA Newsl. 2001; 65(3):16-17,29.
Gravenstein JS, Steinhaus JE. The origin of the anesthesiologist assistant. ASA Newsl. 2003: 67(3):5-6.
The Web site of the American Association of Anesthesiologist Assistants. www.anesthetist.org.
The Web site of the American Association of Nurse Anesthetists. www.aana.com.
FAQs about AAs. ASA Website. www.asahq.org/career/aa.htm.
D
deleted6669
thanks for the above.
definitely a well done and unbiased study.
definitely a well done and unbiased study.
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The experience required for application to CRNA schools varies by the institution. The one year acute care experience is the bare minimum and likely will not get you in, as competition dictates. Also, some nurses have experience in more than one area, like a specialty ICU (shock/trauma, CICU, neuro ICU...) and then PACU or OR. But to answer your question specifically, yes PICU and NICU can be acceptable in some institutions.
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-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🙂
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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.
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.
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So you take an uninformed dig at AA's without accompanying rationale, and then go off on multiple rants in a paragraph-less post about how great ICU nurses are in following protocols, CRNA education and how they compare to NP's? Sheesh. Try to organize your thoughts a little.
Your opinion about AA's is clearly uninformed, and you have bought into the AANA party-line which is basically that AA's are the enemy (I guess you missed the lecture that anesthesiologists are the enemy as well). I would guess you know ZERO about AA's and AA education other than what you've heard online or from one of your CRNA Politics 101 classes.
I hate the "CRNA's have been around for more than 100 years" line. YOU haven't been around that long, so who cares? What's your point? AA's have now been around for more than 40 years. So you'll always have a 60-year jump on AA's. So what? How does that make any useful comparison between the two professions?
What does being a mom and not wanting to work 80 hours a week and make $300k a year have to do with anything?
My practice has a ton of both AA's and CRNA's. We teach both AA and CRNA students. We want to hire outstanding anesthesia practitioners, regardless of the initials after their name. We don't hire people with attitude and honestly don't care much about how much experience you had prior to going to anesthesia school.
And BTW, despite your opinion to the contrary, the fact is a LOT of nurse anesthesia students get accepted to their programs with just that minimum one year of ICU experience, and many of those are accepted PRIOR to finishing that year and with the proviso that they actually finish that one year prior to starting their program. Oh, and in case you didnt know, the ICU experience requirement as well as the BSN requirement are relatively recent phenomena. There are thousands of practicing CRNA's with no nursing degree of any type and no ICU experience. They went straight out of a diploma nursing school into a certificate-only community hospital CRNA school and have never done a day of bedside nursing in their life, much less spent a year in an ICU.
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I'm sorry, I didn't mean to imply that there isn't ANY critical thinking going on... but those patients, for the most part, are going to have mostly the same 'group' of complications. If you want to talk about pure critical thinking ability, I could argue that engineers have a leg up on nurses/respiratory therapists/etc... talk about being able to analytically dissect a problem!
I agree that protocols exist everywhere, but the difference being that the ER physician (in your example) has the authority to deviate from that protocol if he/she feels like it. That person is critically evaluating the protocol (hopefully😀) as it relates to their patient. We had TONS of protocols in my RT department, which was REALLY nice so we didn't have to call the physicians anytime we wanted to do something. These protocols were signed off by our medical director/etc. We were not allowed to deviate from the protocol at all, though. There is a different level of thinking going on there.
I'm not trying to disrespect nurses... I was trying to point out some flaws in your initial statement, which WAS disrespectful. I also don't think that it would take "several years" for an AA and a CRNA to "be on the same level". Have you worked with, or interacted with any AA on a personal/professional level? Just wondering... also wondering why you decided to resurrect a 3.5 year old thread to make this blanket statement?
Respectfully,
RT2MD
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You don't seem to know what you are talking about here. Why the disrespect for your colleagues?
I spent 16 years of my 19 years in nursing floating through all the critical care units at UMass hospital system, have a 4.0 BSN from a 1st tier school, a CCRN, CSC and CMC, damn good GRE scores and was well qualified to attend CRNA school had I wanted to. It was simply not what I wanted to do. That doesn't make what I do (FNP) less than what you do, nor does my choice say anything about my intelligence, work ethic or interpersonal skills. You post however, suggests quite a bit about yours. Hopefully you just had a bad day. Perhaps a NP student took your parking space and you needed to vent. I'd hate to think your post represents an accurate summary of your feelings about your nursing colleagues. That would be a shame.
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A bit off topic, but it doesn't much matter to me regarding significant differences. I want a physician passing my gas.
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Plan ahead - there are a LOT of hospitals where it simply isn't done that way, even if there are anesthesiologists on staff.
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Wouldn't it get a little expensive to call a physician every time you needed to pass gas?
Sorry, I couldn't resist... and yes, I AM 12 years old. 😀
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