CRNA with DNAP on SDN?

[BLADEMDA]

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I was wondering if CRNA's will be given a forum on SDN once the DNAP becomes the norm in a few years. Optometry has a forum so will the Dr. CRNA be given one as well? Or, will www.allnurses.com remain their main site?


One more thing. Since the CRNA is here to stay and the Dr. CRNA is just around the corner I was curious if the ASA every thought of "certifying" the CRNA through our board? While this would "legitimize" the CRNA it would also maintain "quality" for the public.

Here would be my ABA "certified" Nurse Anesthetist:

1. Three years of clinical work experience after CRNA school plus DNAP/PhD
2. Fully Certified CRNA with at least 80% on their test
3. A certain % score on the ANESTHESIOLOGY BOARDS (15th percentile?)
4. A case log showing proficiency in all aspects of Anesthesia (Regional Blocks, line placement, fiberoptic intubation) signed off by TWO Board Certified Anesthesiologists
5. Oral Board Exam by the ABA (not sure about this one)
6. Good Moral Character

The reason I am mentioning this as an option at all is because the public deserves a competent Independent Practitioner with real standards. Once a few hundred Dr. CRNA's become "certified" they will join us in DEMANDING a good standard for Independent practice of Anesthesia.


Blade

 

[Coastie]

Uh..

I was wondering if CRNA's will be given a forum on SDN once the DNAP becomes the norm in a few years. Optometry has a forum so will the Dr. CRNA be given one as well? Or, will www.allnurses.com remain their main site?


One more thing. Since the CRNA is here to stay and the Dr. CRNA is just around the corner I was curious if the ASA every thought of "certifying" the CRNA through our board? While this would "legitimize" the CRNA it would also maintain "quality" for the public.

Here would be my ABA "certified" Nurse Anesthetist:

1. Three years of clinical work experience after CRNA school plus DNAP/PhD
2. Fully Certified CRNA with at least 80% on their test
3. A certain % score on the ANESTHESIOLOGY BOARDS (15th percentile?)
4. A case log showing proficiency in all aspects of Anesthesia (Regional Blocks, line placement, fiberoptic intubation) signed off by TWO Board Certified Anesthesiologists
5. Oral Board Exam by the ABA (not sure about this one)
6. Good Moral Character

The reason I am mentioning this as an option at all is because the public deserves a competent Independent Practitioner with real standards. Once a few hundred Dr. CRNA's become "certified" they will join us in DEMANDING a good standard for Independent practice of Anesthesia.


Blade

 

[BLADEMDA]

Uh..

I am not certain about your response. Yes, I expect your first reaction to be extremely negative and reactionary. But, think about the real world issue and the OPT OUT STATES in existence right now. Forget about politics and money for a minute and think about the patients. Don't they deserve a well-qualified CRNA in the opt-out States and in rural locations (South Texas)?

The "certified" CRNA does not make them "equal" to a Physician just more capable than your run of the mill CRNA. Like it or not, the Independent CRNA is here to stay so while my idea may NOT be the answer it does "regulate" the problem and increase the odds John Q. Public gets a good provider even in BFE.

Blade

 

[badgas]

Uh... what happened to fighting to stop their nonsense?

 

[stanleykristian]

I am all for furthering my education and training. In my program we were kept away from most regional and educational cases, since then I have had to learn regional the hard way, for the patients and me. Can do it now. Many CRNA's I know are profecient in all of these "technical" skills. Doubt if they feel like proving themselves seeing as they perform them routinley.

 

[BLADEMDA]

I am all for furthering my education and training. In my program we were kept away from most regional and educational cases, since then I have had to learn regional the hard way, for the patients and me. Can do it now. Many CRNA's I know are profecient in all of these "technical" skills. Doubt if they feel like proving themselves seeing as they perform them routinley.

Really? Most CRNA's are MARGINAL in their skills and many are down right DANGEROUS! My proposal is to protect the public and not your ego. The best and brightest CRNA with DNAP may find this extra "certification" as way to PROVE their superior knowledge and skill from the run of the mill.
I know a few CRNA's who would agree with me: All CRNA's are NOT CREATED EQUAL my friend. The community college graduate with bridge to a BSN then barely getting by in a "weak" CRNA school is not the same caliber as the Georgetown or Cleveland Clinic graduate. The public deserves better than AANA rhetoric about the "average" CRNA being Equal to an MD. No way.

The "certification" by a real medical board, the ABA, would ensure the public gets a real good provider and counter the AANA rhetoric that we are trying to keep nurses out of the profession.
ON the contrary, we are trying to keep your "average" CRNA from killing patients and my proposal is proof that some of us are more concerned with QUALITY than our pocket books.

Blade

 

[BLADEMDA]

Uh... what happened to fighting to stop their nonsense?

Who said we shouldn't fight the good fight? But, the reality is the ASA and ABA will NEVER do what is required to win. At this point, I am not sure they could win even if they tried.

The idea to REGULATE the Independent CRNA is one that the ASA should have embraced a decade ago. Since there are not enough providers in the USA AND CRNA's are ALREADY practicing independently my proposal is based more on pragmatism than fundamental belief.

My idea must be part of larger strategy for the survival of the specialty. But, I guarantee just sitting on the stool and giving gas is not the long term answer.

Blade

 

[BLADEMDA]

Yes,

You read it right. If my proposal was adopted by the leadership we would admit ABA Certified CRNA's as members of the ASA. These Nurses would ensure that the AANA can not run wild on the public. After a few hundred NURSE ANESTHETISTS with DNAP or PhD's become Certified they would testify that ONLY THE BEST should practice Independently. The "average" CRNA would be prevented from killing patients on their own.

By creating a pathway through our organization we can ensure the public gets good providers. At the same time, we reduce Residency slots and make the Fellowship year Mandatory. This advances our specialty of perioperative medicine while allowing the best and brightest Nurse Anesthetists to advance as well.

As Mil MD has said many times the future of our field is NOT sitting on the stool.

Blade

 

[CremeSickle]

Geez Blade for a sec i thought u went crazy.

Just in case u had not noticed, not all anesthesiologists (or ppl who call themselves anesthesiologists) are created equal either. Not to mention all the foreign grads we get, many of which suck.

If your looking to get CRNAs on board with this idea its probably best not to say that most of them are marginal and you want to keep them from killing patients. Thats not gonna win you any friends bub from the CRNA camp.

I dont know what i think of the idea at all. Ill get back to you after i chat with my mother about it. I vaguely remember her telling me there was a time the ASA offered this very thing to the AANA... but im not sure

Really? Most CRNA's are MARGINAL in their skills and many are down right DANGEROUS! My proposal is to protect the public and not your ego. The best and brightest CRNA with DNAP may find this extra "certification" as way to PROVE their superior knowledge and skill from the run of the mill.
I know a few CRNA's who would agree with me: All CRNA's are NOT CREATED EQUAL my friend. The community college graduate with bridge to a BSN then barely getting by in a "weak" CRNA school is not the same caliber as the Georgetown or Cleveland Clinic graduate. The public deserves better than AANA rhetoric about the "average" CRNA being Equal to an MD. No way.

The "certification" by a real medical board, the ABA, would ensure the public gets a real good provider and counter the AANA rhetoric that we are trying to keep nurses out of the profession.
ON the contrary, we are trying to keep your "average" CRNA from killing patients and my proposal is proof that some of us are more concerned with QUALITY than our pocket books.

Blade

 

[Planktonmd]

Yes,

You read it right. If my proposal was adopted by the leadership we would admit ABA Certified CRNA's as members of the ASA. These Nurses would ensure that the AANA can not run wild on the public. After a few hundred NURSE ANESTHETISTS with DNAP or PhD's become Certified they would testify that ONLY THE BEST should practice Independently. The "average" CRNA would be prevented from killing patients on their own.

By creating a pathway through our organization we can ensure the public gets good providers. At the same time, we reduce Residency slots and make the Fellowship year Mandatory. This advances our specialty of perioperative medicine while allowing the best and brightest Nurse Anesthetists to advance as well.

As Mil MD has said many times the future of our field is NOT sitting on the stool.

Blade

And how many of these Doctor CRNA's are going to meet these requirements and pass the tests?
😉
And do you think their Union (association) will ever allow it?

 

[BLADEMDA]

Geez Blade for a sec i thought u went crazy.

Just in case u had not noticed, not all anesthesiologists (or ppl who call themselves anesthesiologists) are created equal either. Not to mention all the foreign grads we get, many of which suck.

If your looking to get CRNAs on board with this idea its probably best not to say that most of them are marginal and you want to keep them from killing patients. Thats not gonna win you any friends bub from the CRNA camp.

I dont know what i think of the idea at all. Ill get back to you after i chat with my mother about it. I vaguely remember her telling me there was a time the ASA offered this very thing to the AANA... but im not sure

I am just calling it like I see it every day. How many new graduate CRNA's have your worked with? For that matter, how many CRNA's do you really think SHOULD practice Independently? Only the BEST should be permitted that right and ONLY because we are pretty much stuck with it.

I am NOT trying to win friends among the average/marginal CRNA population.
I prefer a quality provider for the public's safety. My proposal ensures that and would be embraced by the BEST CRNA's if offered.

As for our specialty we have a tough process with a long training process.
The "minimum" standard is much higher than the AANA's. The "average" Board Certified Anesthesiologist is very competent and safe. The "average" CRNA is not qualified to practice Independently.

Blade

 

[BLADEMDA]

And how many of these Doctor CRNA's are going to meet these requirements and pass the tests?
😉
And do you think their Union (association) will ever allow it?

How could they LEGALLY prevent a CRNA with DNAP from joining another organization or taking a test? Remember, my pathway is IN ADDITION to the AANA pathway already in existence. While the AANA would not like it they would LEGALLY be in no position to prevent it.

The "extra" layer of certification would create a schism in the AANA over time. The best and brightest CRNA's would become ABA certified and join the ASA. When the AANA tries to make absurd claims about the "quality" of its average members these AANA/ASA/ABA Dr. CRNA's would be the FIRST ONES to counter their claims.

A pathway with regulation is the solution. The alternative is to allow ALL CRNA's to wreak havoc on the public.

Blade

 

[Coastie]

Exactly. That's what my Uh..was about.

Uh... what happened to fighting to stop their nonsense?

 

[stanleykristian]

I find most CRNA's are quite competent and not on the edge of killing their patients. As one surgeon said, int he United States medicine is so good that the good are average. Competence is the minimum standard. Seeing as he was speaking to me about anesthesia at the time and I am the only provider at my hospital It was me he was speaking about.
It is not that I am great, far from it. But I am competent to provide safe quality anesthesia. If you consider the time in preop to PACU as practicing medicine I guess I am doing that. If reading an echo report is medicine then I am doing it, not because I am great but because I like many others have been trained to take this information and apply it to the practice of anesthesia. Now my practice is bread and butter. Lap choles, shoulder scopes and OB. I am not doing any hearts or heads and frankly don't want to. It does not pay as well and the risks are much higher. I am not the best, I am average, and you will find thousands of just as qualified average CRNA's out there.
Please not looking for a fight and I appreciate the goal of the safest provider possible with the best skills possible, Just do not think the ones who have done it hundreds or even thousands of times are interested in proving it to you me or anyone else.

 

[dhb]

Not to mention all the foreign grads we get, many of which suck.

😱 Foreign grads have to go through residency as every US grad so how can they be so inferior? do you have first hand experience? maybe it is your program that sucks... if you're a resident that is 😕

 

[proclivity]

I am just calling it like I see it every day. How many new graduate CRNA's have your worked with? For that matter, how many CRNA's do you really think SHOULD practice Independently? Only the BEST should be permitted that right and ONLY because we are pretty much stuck with it.

I am NOT trying to win friends among the average/marginal CRNA population.
I prefer a quality provider for the public's safety. My proposal ensures that and would be embraced by the BEST CRNA's if offered.

As for our specialty we have a tough process with a long training process.
The "minimum" standard is much higher than the AANA's. The "average" Board Certified Anesthesiologist is very competent and safe. The "average" CRNA is not qualified to practice Independently.

Blade

You would be better off by increasing standards for admission to CRNA school. A cursory perusal shows the average GRE only around 1000 and some change.

Current requirements are meager for the "easiest" to get into and markedly more difficult for other top tier schools with them requiring biochemistry, physics, organic chemistry and statistics.

The ASA certification of CRNAs in rather obnoxious, IMO. What is the point of all of this when they could go to medical school with the same prereqs and investment of time.......and no i'm not saying its easy to get into medical school....so get that out of your system before you start typing.

 

[CremeSickle]

Well as i understand it (i may be wrong) a foreign trained anesthesiologist simply has to take the exam not a full residency (i dont mean those who just goto med school in the Caribbean and apply for residency as FMGs).

Not to mention the significant number of people practicing anesthesiology what are NOT board certified at all. From what the chief anesthesiologist at my program says this a big issue.

😱 Foreign grads have to go through residency as every US grad so how can they be so inferior? do you have first hand experience? maybe it is your program that sucks... if you're a resident that is 😕

 

[urgewrx]

Well as i understand it (i may be wrong) a foreign trained anesthesiologist simply has to take the exam not a full residency (i dont mean those who just goto med school in the Caribbean and apply for residency as FMGs).

Dude, you blew it.

It is blatantly clear that you are a CRNA.

I always knew it.

 

[badgas]

Just an odd post to me... very out of character for Blade. It's like an ophthalmologist posting "well, optometrists are gonna win and be able to do surgery anyways, so lets try to get them better trained." It makes no sense. That is the kind of attitude that is going to screw us worse. Yeah we are in a bit of a hole, but lets dig ourselves out of it! Why wave the white flag and concede that they should be able to practice independantly? Why not lobby and try to put an end to the crap? Who cares what they call themselves... they are still nurses and a nurse will never be allowed to call themself a doctor inside a hospital.

 

[CremeSickle]

huh?

How would i know about the requirements for coming from overseas? Im not one. Thats why i said "as i understand it (i may be wrong)".

Truly, i could care less what you (or anyone else) believe. Ive told you my background and what I am, believe what you will.

Dude, you blew it.

It is blatantly clear that you are a CRNA.

I always knew it.

 

[urgewrx]

huh?

How would i know about the requirements for coming from overseas? Im not one. Thats why i said "as i understand it (i may be wrong)".

If you were a physician, you would know. But, since you are a nurse, you don't know crap. This is a fact of life. This is why nurses need to be supervised.

 

[Bertelman]

Just an odd post to me... very out of character for Blade.

Not really. You can count on Blade (or his predecessor) to throw a new twist on the CRNA debate every few weeks. I think it's his way of keeping the discussion fresh without annoying others.

 

[stanleykristian]

Today 88Y/O male with urethral bleeding, entered hospital hypotensive 64/47 after bleeding for days. pt has CHF 25% EF, aortic murmur and mitral murmur, post renal failure with creatinine of 11 and BUN of 64. Cysto with TURP. H/H 8.6 and 24.3.
I ordered 2units prbc and a BMP, EKG and old chart. Echo report 7 months old gives a RVP of 50mmhg minor aortic and tricuspid regurgitation, EKG NSR with RBBB with occasional PVC, BMP Na, 128,cl 98, K5.2.
Decided to do spinal using .5%ropivicaine due to echo report and previous hypotension indicating no AS.
Did I practice medicine or just good Judgment. Patient did fine.

 

[CremeSickle]

Wow.

How do you fit that big ego in the same room as the surgeons?

Let me reiterate since you seem to be missing it; I dont care WHAT you believe as its irrelevant to me.

If you were a physician, you would know. But, since you are a nurse, you don't know crap. This is a fact of life. This is why nurses need to be supervised.

 

[urgewrx]

Today 88Y/O male with urethral bleeding, entered hospital hypotensive 64/47 after bleeding for days. pt has CHF 25% EF, aortic murmur and mitral murmur, post renal failure with creatinine of 11 and BUN of 64. Cysto with TURP. H/H 8.6 and 24.3.
I ordered 2units prbc and a BMP, EKG and old chart. Echo report 7 months old gives a RVP of 50mmhg minor aortic and tricuspid regurgitation, EKG NSR with RBBB with occasional PVC, BMP Na, 128,cl 98, K5.2.
Decided to do spinal using .5%ropivicaine due to echo report and previous hypotension indicating no AS.
Did I practice medicine or just good Judgment. Patient did fine.

Why ropivacaine?

 

[BLADEMDA]

Today 88Y/O male with urethral bleeding, entered hospital hypotensive 64/47 after bleeding for days. pt has CHF 25% EF, aortic murmur and mitral murmur, post renal failure with creatinine of 11 and BUN of 64. Cysto with TURP. H/H 8.6 and 24.3.
I ordered 2units prbc and a BMP, EKG and old chart. Echo report 7 months old gives a RVP of 50mmhg minor aortic and tricuspid regurgitation, EKG NSR with RBBB with occasional PVC, BMP Na, 128,cl 98, K5.2.
Decided to do spinal using .5%ropivicaine due to echo report and previous hypotension indicating no AS.
Did I practice medicine or just good Judgment. Patient did fine.

Look,

This thread is not about you, your cases or your experience. It is about CRNA arrogance and lack of formal edcation/training. My pathway is a means to PROVE competence and experience like we have to do BEFORE becoming Board Certified practitioners.

Are you scared that you can't score 15th percentile on our exam? Or, are you concerned that the DNAP or PhD becomes the new minimum standard for Independent CRNA practice? Regardless, the current AANA stance that EVERY CRNA be treated the same and be given the same practice rights is dangerous. The public wouldn't stand it for it PROVIDED there were options like a ABA Certified CRNA to do the job. The extra qualifications is proof of a higher standard. A standard that the BEST CRNA's can meet or exceed.

Sorry if you fall short but our Citizens deserve the BEST we have to offer. In BFE that would mean an ABA Certified CRNA while in Big City USA it means a Board Certified Anesthesiologist Solo or via the ACT model.

Blade

 

[BLADEMDA]

Just an odd post to me... very out of character for Blade. It's like an ophthalmologist posting "well, optometrists are gonna win and be able to do surgery anyways, so lets try to get them better trained." It makes no sense. That is the kind of attitude that is going to screw us worse. Yeah we are in a bit of a hole, but lets dig ourselves out of it! Why wave the white flag and concede that they should be able to practice independantly? Why not lobby and try to put an end to the crap? Who cares what they call themselves... they are still nurses and a nurse will never be allowed to call themself a doctor inside a hospital.

I see your point and I am sympathetic to the cause. I wholeheartedly agree on the FULL ASSAULT/FULL METAL JACKET approach to the AANA problem.

But, the universities continue to MASS PRODUCE CRNA's at record levels. New CRNA programs are opening across the country while the AA movement is hardly noticeable. Where is the strategy? Where is the logic to our plan (we have none)? The number of Residency slots are limited while CRNA schools can open at every major hospital. The best lobbying will do is SLOW the AANA down for a bit.

What about John Q. Public and CRNA's like STANLEY/RMH? Doesn't the public deserve the BEST CRNA if NO MD/DO is available? The AANA isn't going to step on any toes for the public's sake. On the contrary, they will lobby EVERY CRNA is capable of Independent Practice. Crap. At least my proposal only allows extremely competent CRNA's to practice Independently. The fact is a CRNA that can pass our exams, has three years of experience and meet my other requirements is a better "quality" provider for BFE.

Those CRNA's wanting to act like a Doctor and practice Medicine SOLO will have their opportunity to do so. Only under my proposal they need to PROVE a higher level of competence and knowledge than the "average" CRNA to do so. A far better situation for the patient that we have today.

Blade

 

[BLADEMDA]

That is how I see our specialty. Anesthesiology must move from "stool sitting" into perioperative medicine. There is no way we can maintain the "staus quo" against the AANA for twenty more years. Ten more maybe but a real strategy is needed for dealing wth the issue.

Either open up a dozen more AA schools and start producing a competitor to the CRNA or deal with the realization that the AANA will not stop at being a MidLevel Provider forever. They want the WHOLE cake and the icing as well.
My preference is for the AA schools but the support simply isn't there.

This brings up the issue of "weak" CRNA's practicing Independently under the protection of the AANA. My proposal tackles that problem head-on and brings the BEST CRNA's into the battle for patient safety. While I don't like the idea it is very pragmatic. Our Specialty must evolve or die. Don't bet your long term future on being a stool sitter. In the long run, the AANA is going to win that gig.

Blade

 

[BLADEMDA]

Just an odd post to me... very out of character for Blade. It's like an ophthalmologist posting "well, optometrists are gonna win and be able to do surgery anyways, so lets try to get them better trained." It makes no sense. That is the kind of attitude that is going to screw us worse. Yeah we are in a bit of a hole, but lets dig ourselves out of it! Why wave the white flag and concede that they should be able to practice independantly? Why not lobby and try to put an end to the crap? Who cares what they call themselves... they are still nurses and a nurse will never be allowed to call themself a doctor inside a hospital.

FACT:

Optometrists are NOT currently practicing Surgery. Thus, Optho will fight like MAD to keep them out.

FACT:

CRNA's are Practicing Anesthesiology/Anesthesia without an MD/DO TODAY SOLO across the USA.

FACT:

We have no long term strategy for dealing with the AANA's Assault. Many Chairpersons/PD's are SELLING out the profession to the AANA for cheap labor ($$$). They are your worst enemy and NOT the AANA(second).

Blade

 

[badgas]

That is how I see our specialty. Anesthesiology must move from "stool sitting" into perioperative medicine. There is no way we can maintain the "staus quo" against the AANA for twenty more years. Ten more maybe but a real strategy is needed for dealing wth the issue.

Either open up a dozen more AA schools and start producing a competitor to the CRNA or deal with the realization that the AANA will not stop at being a MidLevel Provider forever. They want the WHOLE cake and the icing as well.
My preference is for the AA schools but the support simply isn't there.

This brings up the issue of "weak" CRNA's practicing Independently under the protection of the AANA. My proposal tackles that problem head-on and brings the BEST CRNA's into the battle for patient safety. While I don't like the idea it is very pragmatic. Our Specialty must evolve or die. Don't bet your long term future on being a stool sitter. In the long run, the AANA is going to win that gig.

Blade

Why isn't one of the "solutions" simply replacing CRNAs with... US. There are now more than 1300 anesthesia residency graduates per year. 10 years ago there were like 200. Obviously that left a gap that CRNAs are feeding off of. Now that there are more anesthesiologists, why don't we just take back what is ours? There may be a pay cut, but who cares. I'd happily take a pay cut if it meant that I could do what I want and not have to deal with rounding, daily glucose monitoring and constipation management that is "perioperative medicine." I chose anesthesia to do anesthesia. I would have picked IM and a CC fellowship if I really wanted to just deal with that stuff. I also absolutely agree with getting the ball rolling w/ AA schools. It seems like progress is being made, so I don't know why you seem down on that now.

 

[stanleykristian]

Look the point is I am an average CRNA the desicions I made were based on my education as an anesthesia provider. Can I score in the 15TH percent on the boards, yes. If I spent the time that I have seen attendings study . I scored top 2% verbal on gre and top 10% math. The reason I bring up the case is I am an average CRNA 6 months out of school and I provide safe care interpting data and making clinical decisions on this data.
Look I know case is small potatoes for you I have read your cases and have found them very informative and your experiance far outweighs mine, but CRNA's for the most part are not mediocre or unsafe. That is the point

 

[BLADEMDA]

I find most CRNA's are quite competent and not on the edge of killing their patients. As one surgeon said, int he United States medicine is so good that the good are average. Competence is the minimum standard. Seeing as he was speaking to me about anesthesia at the time and I am the only provider at my hospital It was me he was speaking about.
It is not that I am great, far from it. But I am competent to provide safe quality anesthesia. If you consider the time in preop to PACU as practicing medicine I guess I am doing that. If reading an echo report is medicine then I am doing it, not because I am great but because I like many others have been trained to take this information and apply it to the practice of anesthesia. Now my practice is bread and butter. Lap choles, shoulder scopes and OB. I am not doing any hearts or heads and frankly don't want to. It does not pay as well and the risks are much higher. I am not the best, I am average, and you will find thousands of just as qualified average CRNA's out there.
Please not looking for a fight and I appreciate the goal of the safest provider possible with the best skills possible, Just do not think the ones who have done it hundreds or even thousands of times are interested in proving it to you me or anyone else.

Here is analogy that you MAY understand. I will go slow for you. If I wanted to evaluate a race car driver for skill/competence who would I hire for the task?
A surgeon? A CRNA? No! I would hire another race car driver preferably one with a lot of WINS during his career.

Here is another analogy. If I wanted to evaluate a fighter pilot for skill/competence who would I hire for the task? My local weekend pilot? No.
I would hire the BEST fighter pilot possible.

Now let us move to ANESTHESIA. If I wanted to evaluate an Independent Anesthesia Provider for competence/skill who would I hire? A CRNA? A surgeon? No. I would hire the BEST Board Certified Anesthesiologist possible with years of experience.

My point is that you have NO IDEA what you don't know. This is what makes you dangerous. You are NOT qualified to practice Medicine or Anesthesiology let alone determine who is. That role is for BOARD CERTIFIED ANESTHESIOLOGIST PHYSICIANS.

My proposal is a way for the BEST provider the USA has available to test knowledge/skill for CRNA's to practice Solo in BFE. My goal is for the safest/highest quality provider for the public.

Blade

 

[Planktonmd]

Today 88Y/O male with urethral bleeding, entered hospital hypotensive 64/47 after bleeding for days. pt has CHF 25% EF, aortic murmur and mitral murmur, post renal failure with creatinine of 11 and BUN of 64. Cysto with TURP. H/H 8.6 and 24.3.
I ordered 2units prbc and a BMP, EKG and old chart. Echo report 7 months old gives a RVP of 50mmhg minor aortic and tricuspid regurgitation, EKG NSR with RBBB with occasional PVC, BMP Na, 128,cl 98, K5.2.
Decided to do spinal using .5%ropivicaine due to echo report and previous hypotension indicating no AS.
Did I practice medicine or just good Judgment. Patient did fine.

You did a spinal on a hypotensive, hypovolemic patient, and you want to tell us that you are proud you got away with it! and on top of that you want to call it practice of medicine!

 

[BLADEMDA]

Look the point is I am an average CRNA the desicions I made were based on my education as an anesthesia provider. Can I score in the 15TH percent on the boards, yes. If I spent the time that I have seen attendings study . I scored top 2% verbal on gre and top 10% math. The reason I bring up the case is I am an average CRNA 6 months out of school and I provide safe care interpting data and making clinical decisions on this data.
Look I know case is small potatoes for you I have read your cases and have found them very informative and your experiance far outweighs mine, but CRNA's for the most part are not mediocre or unsafe. That is the point

See my previous post. Paste it here.

 

[BLADEMDA]

Why isn't one of the "solutions" simply replacing CRNAs with... US. There are now more than 1300 anesthesia residency graduates per year. 10 years ago there were like 200. Obviously that left a gap that CRNAs are feeding off of. Now that there are more anesthesiologists, why don't we just take back what is ours? There may be a pay cut, but who cares. I'd happily take a pay cut if it meant that I could do what I want and not have to deal with rounding, daily glucose monitoring and constipation management that is "perioperative medicine." I chose anesthesia to do anesthesia. I would have picked IM and a CC fellowship if I really wanted to just deal with that stuff. I also absolutely agree with getting the ball rolling w/ AA schools. It seems like progress is being made, so I don't know why you seem down on that now.

This thread is just another idea. My preference is for all out war with the AANA. That is why I chose BLADEMDA/MD WARRIOR as my handle. THe public is being duped by community college graduates with Bridge BSN follwed by community hospital SRNA school. If only you knew the truth about "average" CRNA in our country.

The leadership is impotent and inept. Worse. They have joined with the enemy to make a few more dollars. My proposal was stated for the benefit of the public. There are a few thousand CRNA's practicing solo across the USA today. This is fact my friend. My proposal at least creates a standard to protect our citizens from the ignorant "average" CRNA who has no business practicing Medicine.

The funny thing is one of my best CRNA's came up with the idea. He told me in private the same thing I am telling you here. The AANA could care less about "quality" because they want NUMBERS. He is the one that boldy told me "all CRNA's are not equal-not even close."

Blade

 

[BLADEMDA]

Our slots are LIMITED. We can not produce more Anesthesiologists than we are doing today. We are "maxed-out" unlike the CRNA. In addition, the universities have figured this out and are RUSHING to create even MORE CRNA's.

Our only option to the CRNA is the AA. More of us is not a viable soluton.

Blade

 

[stanleykristian]

at induction bp 120/50 had ben fluid resucitated. Of course I did not place the spinal in a patient with a bp of 60/43. and I did not call it medicine I asked what do you call. I am not proud that I made the right decisions based on the clinical situation, I did as I was taught, evaluated the clinical data devised a care plan appriate to the situation and executed it bp never dropped less then 89 systolic.

 

[stanleykristian]

I will go slow for you. CRNA's are safe. we evaluate the data, note anesthesia is practiced everyday without an anesthesiologist and yet the patients survive and do well. The primary difference in delivering anesthetic care since these are just technical things according to many posts between an anesthesiologis and a CRNA is NONE.

 

[stanleykristian]

I have found less profound hypotension using .5% ropivicaine then .75% bupivicaine.

 

[Taurus]

CRNA's are glorified technicians, period.

 

[rmh149]

Blade,

Your thoughts make alot of sense. If a vote were to be posted today, I would vote for it. I agree that DNAP CRNA's should have more qualifications/residency time and number of cases to distinguish them from the CRNA's that are grandfathered into the field. I would be all over seeking those credentials even though I would be grandfathered. However, there are a ton of CRNA's already practicing independently that do not want to put in the extra work...maybe because they are 5 or 7 years from retirement....whatever their case may be.

What do you think about making the independent requirement for those graduating now....and grandfathering those already practicing independently? They of course have the option to acquire the certification, but not required? I know this means that it will take many many years before ALL independent CRNA's are ABA certified....but it is a start toward higher standards of care provided to the public.

Now, will this decrease the number of CRNA applicants? Maybe....but not by much I believe. Will it ensure that the brightest and the best apply....I think so. My hope is that the number of anesthesiology residencies will increase, the CRNA standards will increase, and the public will have enough providers to meet the demand. I dont think it will be benificial for either group to take over the other. It is always good to keep eachother in check dont you think?

 

[BLADEMDA]

I will go slow for you. CRNA's are safe. we evaluate the data, note anesthesia is practiced everyday without an anesthesiologist and yet the patients survive and do well. The primary difference in delivering anesthetic care since these are just technical things according to many posts between an anesthesiologis and a CRNA is NONE.

You would know right? Who gave you the right to practice medicine?
Who evaluated your qualifications for Independent Practice? Does the public know you are INEXPERIENCED and a Nurse Anesthetist. There is no way a CRNA with 6 months of experience should be practicing Independently. Most of my ABOVE AVERAGE CRNA's would agree with that statement. Fortunately, you are the exception and not the rule for solo CRNA practice. The average Solo CRNA is very experienced.

Again, the BEST the USA has to offer should EVALUATE and JUDGE Independent Anesthesia Providers. This means an experienced Board Certified Anesthesiologist and the passing of a REAL EXAM with tough standards.

Our current situation of allowing newbie CRNA's to practice SOLO in the USA is a disgrace.

Blade

 

[stanleykristian]

Did I practice medicine? If so the state gave me the authoraty to do what I did, and the point is that we are trained and trained well. I can see we are going to continue to disagree on this issue. good luck see you round

 

[johankriek]

The "certification" by a real medical board, the ABA, would ensure the public gets a real good provider and counter the AANA rhetoric that we are trying to keep nurses out of the profession.
ON the contrary, we are trying to keep your "average" CRNA from killing patients and my proposal is proof that some of us are more concerned with QUALITY than our pocket books.

Blade

why would a medical board train, test and certify nurses?? they are in the business of certifying physicians.. I like the effort blade. try again..

you wanna win?DO YOUR OWN CASES.. SIT IN THAT ROOM ALL DAY EVERYDAY>> DO NOT SUPERVISE NURSE ANESTHETISTS>>

 

[BLADEMDA]

Blade,

Your thoughts make alot of sense. If a vote were to be posted today, I would vote for it. I agree that DNAP CRNA's should have more qualifications/residency time and number of cases to distinguish them from the CRNA's that are grandfathered into the field. I would be all over seeking those credentials even though I would be grandfathered. However, there are a ton of CRNA's already practicing independently that do not want to put in the extra work...maybe because they are 5 or 7 years from retirement....whatever their case may be.

What do you think about making the independent requirement for those graduating now....and grandfathering those already practicing independently? They of course have the option to acquire the certification, but not required? I know this means that it will take many many years before ALL independent CRNA's are ABA certified....but it is a start toward higher standards of care provided to the public.

Now, will this decrease the number of CRNA applicants? Maybe....but not by much I believe. Will it ensure that the brightest and the best apply....I think so. My hope is that the number of anesthesiology residencies will increase, the CRNA standards will increase, and the public will have enough providers to meet the demand. I dont think it will be benificial for either group to take over the other. It is always good to keep eachother in check dont you think?

At least you grasp the concept of allowing the BEST to practice Independently for the safety/benefit of the patient. My idea is not to EXCLUDE CRNA's from working in the field but limit those who want to practice SOLO to the most qualified CRNA. An individual with experience (cases make a difference), knowledge (15th percentile on our exam is not easy for a CRNA) and making sure that individual can do more than General Anesthesia (blocks, fiberoptic intubation, spinal, etc.).

As for GRANDFATHERING in Older CRNA's why is that important? My idea will never go further than this board. The AANA would hate it and the ABA would never do it. But, I still think it has merit for the patients.

Blade

 

[Taurus]

Our slots are LIMITED. We can not produce more Anesthesiologists than we are doing today. We are "maxed-out" unlike the CRNA. In addition, the universities have figured this out and are RUSHING to create even MORE CRNA's.

Eventually, the CRNA's are going to overplay their hand and supply more CRNA's than can meet demand.

CRNA's will get squeezed in the future. Increasing numbers of CNRA's and AA's and higher malpractice premiums. They're gonna be boxed into just giving anesthesia because their attempts at scope expansion into pain management and others will not succeed.

 

[rmh149]

Sorry Blade, I am one of those CRNA's....and I do think I am safe (dont hold it against me). I do agree with you though....the standards need to be increased.

Stanley, please stop fighting and think about the original point of the thread. You are independent. You say independent CRNA's are safe. Maybe you are right, maybe you are wrong. I am sure, as I do, that you are comfortable and know your are safe regardless of what others say. Can you say that about ALL independent CRNA's? Increasing the standard and adding certifications to DNAP prepared CRNA's will make it even safer....and better. Do you agree?

Blade, I agree with you 100%. Increasing standards is the only way to maximize quality of care to the American people.

I have no problem with identifying the BEST. If you want to be the best....get the certifications.

 

[BLADEMDA]

why would a medical board train, test and certify nurses?? they are in the business of certifying physicians.. I like the effort blade. try again..

you wanna win?DO YOUR OWN CASES.. SIT IN THAT ROOM ALL DAY EVERYDAY>> DO NOT SUPERVISE NURSE ANESTHETISTS>>

Yes, I know the majority would vote against the idea. But, there is NOTHING stopping the ABA/ASA from doing it. The certificate from the ASA/ABA only has the weight society places on it. No more and no less.

By allowing Dr. CRNA's to take an exam and giving an "affiliate" certificate does not violate any rules I am aware of concerning Physicians. It would be a separate category under ADVANCED DOCTORATE NURSING PROVIDER CERTIFICATE OF COMPETENCY IN ANESTHESIA. We were the first field for Advanced Practices Nurses to go SOLO and we could be the first one to actually certify them under our guidelines as well.

As for my practice I am going to stay put. My next move is to Academics or a semi-retired Pain Practice.

Blade

 

[johankriek]

Blade, I agree with you 100%. Increasing standards is the only way to maximize quality of care to the American people.

.

there is already a standard for independent anesthesia practice in the united states

Board Certification by the American Board

Doctor of Medicine Degree

State medical licensure..

thats the standard...

period..

anything less is spinning your wheels and i would never endorse and neither should any of you..

 

[rmh149]

there is already a standard for independent anesthesia practice in the united states

Board Certification by the American Board

Doctor of Medicine Degree

State medical licensure..

thats the standard...

period..

anything less is spinning your wheels and i would never endorse and neither should any of you..

Johan, I understand your opinion. But it is not fact....because Stanley and I are both independently practicing CRNA's (among many others).....and obvioulsy following the standards in the US. Are we part of Blade's top 15%....who knows. But I think increasing the standards is a good idea.

You have never worked with CRNA's....and I am sure you have not worked with the BEST CRNA's...as Blade has. Knowing that anesthesiologists will never be able to fill the need of this country....why not consider his proposal? Identify the BEST.....increase the standards.