CRNAs fighting for complete removal of supervision

[toughlife]

http://www.asahq.org/Newsletters/2007/04-07/stateBeat04_07.html

2007 Legislation Seeks to Remove Physician Supervision
Requirements

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs


--------------------------------------------------------------------------------

ith all 50 states and the District of Columbia in session, the amount of legislation affecting anesthesiology has increased from last year. Specifically the number of states that could remove physician involvement in the administration of anesthesia has increased. Connecticut, Illinois, New York, Pennsylvania and Utah are facing challenges to existing law that would weaken their laws governing the administration of anesthesia. State component societies in each of these states are actively opposing the legislation described below.

As introduced, Utah S.B. 45 would have removed physician oversight and granted prescriptive authority to nurse anesthetists who had completed an advanced course work in patient assessment, diagnosis, treatment and pharmacotherapeutics. The Utah Society of Anesthesiologists and Utah Medical Association (UMA) worked hard to remove such sections from the bill. As a result, the sponsor amended the bill to delete prescriptive authority and to retain physician oversight. Congratulations to the anesthesiologists in Utah and UMA on their success!

Connecticut law currently requires advanced-practice registered nurses (APRNs) to work in collaboration with a physician. Nurse anesthetists who prescribe and administer medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present. H.B. 7161 would remove both requirements to allow APRNs to work collaboratively with health care providers, which include audiologists, chiropractors, dentists, dental hygienists, podiatrists, radiographers, radiologic technologists, respiratory care practitioners and speech pathologists. The Connecticut Society of Anesthesiologists has submitted written comments in opposition to these changes.

As in previous years, legislation has been introduced in Pennsylvania and New York that would amend existing law in order to expand the scope of practice of a nurse anesthetist. In Pennsylvania, a nurse anesthetist would administer anesthesia in cooperation with a physician, dentist or podiatrist. S.B. 341 defines “cooperation” as each professional working together contributing expertise at his or her individual and respective levels of education and training. Nurse anesthetists would be under the overall direction of the chief or director of anesthesia services, provided that in situations or facilities where anesthesia services are not mandatory the nurse anesthetist would be under the overall direction of the physician, dentist or podiatrist responsible for the patient’s care. If the anesthesia team consists entirely of nonphysicians, the nurse anesthetist would have available, by physical presence or electronic communication, an anesthesiologist or consulting physician of the nurse anesthetist’s choice. The Pennsylvania Society of Anesthesiologists is closely monitoring this bill.

In New York, A.B. 5201 would codify into statute nurse anesthetist scope of practice, which is currently only found in the hospital and ambulatory surgical center regulations. Their scope of practice would include anesthetic induction, maintenance, emergence, postanesthesia care and pain management in collaboration with a physician and pursuant to a written practice agreement and practice protocol. Nurse anesthetists who successfully complete an anesthesia program, including an appropriate pharmacology component (or its equivalent), could prescribe drugs, devices and anesthetic agents. The practice protocol would reflect current accepted medical and nursing practice. Physicians would not enter into practice agreements with more than four nurse anesthetists who are not located on the same physical premises as the collaborating physician.

Lastly, legislation has been introduced that would amend the Illinois Nursing and Advanced Practice Nursing Act in order to remove physician involvement.

Wisconsin
Immediately following the opt-out by Governor Jim Doyle in June 2005, the Wisconsin Society of Anesthesiologists (WSA) challenged its validity by petitioning the medical board for a declaratory ruling that Wisconsin law requires physician supervision of nurse anesthetists. An administrative law judge recently issued a proposed decision and order regarding WSA’s petition. The judge’s recommendation, which is not binding at this time, would require physician supervision and direction of nurse anesthetists. The proposed recommendation, however, would allow nurse anesthetists who received a certificate to prescribe (advance-practice nurse prescriber) to work in a collaborative relationship with a physician. WSA has filed documents with the court objecting to the judge’s recommendations. WSA contends that while Wisconsin law allows those individuals holding such certificate to prescribe (APNP-CRNA) in collaboration with a physician, this law does not extend to the administration of anesthesia. Collaboration applies only to prescriptive authority. Once the judge reviews the objections and issues a final proposed decision, the medical board will issue a binding final decision and order.

---

Members don't see this ad.

 

[urgewrx]

Wouldn't it be easier for these people to go to med school, rather than doing a DNAP and pushing bills year after year?
​

 

[toughlife]

That's because it's easier to be lazy and pay a hungry lawyer to fight to get you practicing privileges rather than to bust your ass and work hard to become a physician.

That is the epitome of laziness as far as I am concerned.

 

[EtherMD]

That's because it's easier to be lazy and pay a hungry lawyer to fight to get you practicing privileges rather than to bust your ass and work hard to become a physician.

That is the epitome of laziness as far as I am concerned.

It looks like you boys are finally starting to see the picture. Now, if you can just get Volatile on board. Perhaps, you want to take another look at my suggestions/predictions in previous threads. This is the beginning of much more once the DNAP becomes the standard.

 

[urgewrx]

http://www.asahq.org/Newsletters/2007/04-07/stateBeat04_07.html In Pennsylvania, a nurse anesthetist would administer anesthesia in cooperation with a physician, dentist or podiatrist. If the anesthesia team consists entirely of nonphysicians, the nurse anesthetist would have available, by physical presence or electronic communication, an anesthesiologist or consulting physician of the nurse anesthetist’s choice.

Now they plan to outsource it to India too.

 

[SleepIsGood]

Now they plan to outsource it to India too.

WHat's even better is anesthesiologists would have to wait for referrals from a CRNA???

 

[Planktonmd]

Every time I read something saying that a CRNA can be supervised by an anesthesiologist or "a physician" it makes me nauseous.
The sad thing is that we reached a point that we consider such language favorable.
This is like saying that a nurse practitioner can practice cardiology under the supervision of a plastic surgeon, or a PA can do orthopedic surgery under the supervision of an internist!
Why is this specialty so underestimated that the medical society and the legislator think that it can be done by just about anyone?
We should be ashamed and outraged.
What a deplorable state this miserable specialty has reached.
I think we all are just a bunsh of pathetic whimps.

 

[EtherMD]

Toughlife,

When I first started posting on SDN you criticized me heavily. You questioned my experience and facts about the specialty. Now, you are realizing that my posts are accurate and reflect the feelings of many CRNA's and the AANA.

I have attempted to post "responses" or damage control to the AANA threat.
Unfortunately, many share the view of Volatile that the threat is over-stated or not present at all. Most like the status quo and attack those like myself that want us to do something soon. Fear and denial are powerful emotions that cause people like Volatile to reject new ideas that may rock the boat.
They view the current situation as less than ideal but manageable. They are wrong and in a few years the AANA will prove it. The key is the DNAP as the new "standard" for CRNA's. Then the rhetoric and propoganda will hit a new level.

I wish that I could tell you we will win. But, the longer we wait to take action the more likely that Anesthesia becomes the realm of the AANA with the ASA taking a back-seat role. We will exist as "helpers/consultants" to the CRNA who will be the primary provider. We have no one to blame except ourselves. The new generation of Anesthesiologists must rise to the occasion and help avert the death of the specialty as you now know it.

 

[toughlife]

Toughlife,

When I first started posting on SDN you criticized me heavily. You questioned my experience and facts about the specialty. Now, you are realizing that my posts are accurate and reflect the feelings of many CRNA's and the AANA.

I have attempted to post "responses" or damage control to the AANA threat.
Unfortunately, many share the view of Volatile that the threat is over-stated or not present at all. Most like the status quo and attack those like myself that want us to do something soon. Fear and denial are powerful emotions that cause people like Volatile to reject new ideas that may rock the boat.
They view the current situation as less than ideal but manageable. They are wrong and in a few years the AANA will prove it. The key is the DNAP as the new "standard" for CRNA's. Then the rhetoric and propoganda will hit a new level.

I wish that I could tell you we will win. But, the longer we wait to take action the more likely that Anesthesia becomes the realm of the AANA with the ASA taking a back-seat role. We will exist as "helpers/consultants" to the CRNA who will be the primary provider. We have no one to blame except ourselves. The new generation of Anesthesiologists must rise to the occasion and help avert the death of the specialty as you now know it.

Not sure I have attacked you in the past, but I am certain I have never dismissed the CRNA threat. Since I started posting in this forum, I have spoken ardently against the CRNAs and have annoyed many with my attacks against them.

The future as I see it is not looking bright for anesthesia in general and I personally think it is time people realize that they will need further training to be competitive.

I think medicine in general and not just anesthesiology is under attack by the nursing community. I think the only way to fight them off is by all specialties to come together and fight as one. The AMA slogan of "Together we are stronger" is befitting.

 

[urgewrx]

The future as I see it is not looking bright for anesthesia in general and I personally think it is time people realize that they will need further training to be competitive.

Maybe, mabe not. I think all anesthesia residents should be certified in Critical Care within the 4 years residency. That's topic for another discussion. Regarding training, nurses will just copy whatever we do. If we do primary care, they do primary care. If we do blocks, they learn blocks. If we do pain, they learn pain. If we subspecialize, they'll subspeciallize. Yes, it might give us the advantage for 10 or 20 years, but they will keep evolving. That's life, dude. Physician anesthesia will be for the selected few who can afford it.

 

[toughlife]

I agree on the nurses copying what physicians do and calling it "the practice of nursing".

 

[SleepIsGood]

Hey Ether

Toughlife overe here NEVER underestimate the threat. Listen, he and I have been here on this forum stating this stuff for the last 2+ years. In fact the reason we put together things like the Anesthesiology Club was to provide a physician only forum.

Listen, all of us agree that the PROBLEM is the CRNA. It's not a problem we can downplay anymore. I think where we clash is our solution for the problem. It seems as though you believe AAs are the route to take. I personally believe that the AAs are going to be just as much a threat as CRNA are now. CRNAs did not start off wanting to practice on their own. They were leaches. They worked in the OR with us, did wht we wanted,etc. NOW...they believe they can practice independently. Do you see what we mean? Who is to say that AAs (who do not express a desire to be independent now) will not create the same havoc for us in 10 years that CRNAs do now?

 

[VolatileAgent]

http://www.asahq.org/Newsletters/2007/04-07/stateBeat04_07.html

2007 Legislation Seeks to Remove Physician Supervision
Requirements

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs

<snip>

this article, and the issues identified therein, have nothing to do with the DNAP designation for advanced practice nurses. why was that brought up?

in fact, if you read carefully (which none of you apparently did), the overwhelming sentiment is that we are winning against the challenges put forth by the AANA and their contingents. they are challenging us, and we are coming out ahead. does this mean that next you should expect them to give up? do you think they are going to suddenly roll-over and play dead? hardly. if anything, this is even further strong evidence that we need to band together and continue supporting the ASA and the ASA-PAC.

if you're going to claim the sky is falling, at least uncover your head, look up, and makes sure that you can actually see the sky.

 

[toughlife]

this article, and the issues identified therein, have nothing to do with the DNAP designation for advanced practice nurses. why was that brought up?

in fact, if you read carefully (which none of you apparently did), the overwhelming sentiment is that we are winning against the challenges put forth by the AANA and their contingents. they are challenging us, and we are coming out ahead. does this mean that next you should expect them to give up? do you think they are going to suddenly roll-over and play dead? hardly. if anything, this is even further strong evidence that we need to band together and continue supporting the ASA and the ASA-PAC.

if you're going to claim the sky is falling, at least uncover your head, look up, and makes sure that you can actually see the sky.

The title of my thread reads "CRNAs fighting" I did not say winning.

 

[jwk]

http://www.asahq.org/Newsletters/2007/04-07/stateBeat04_07.html

2007 Legislation Seeks to Remove Physician Supervision
Requirements

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs


In New York, A.B. 5201 would codify into statute nurse anesthetist scope of practice, which is currently only found in the hospital and ambulatory surgical center regulations. Their scope of practice would include anesthetic induction, maintenance, emergence, postanesthesia care and pain management in collaboration with a physician and pursuant to a written practice agreement and practice protocol. Nurse anesthetists who successfully complete an anesthesia program, including an appropriate pharmacology component (or its equivalent), could prescribe drugs, devices and anesthetic agents. The practice protocol would reflect current accepted medical and nursing practice. Physicians would not enter into practice agreements with more than four nurse anesthetists who are not located on the same physical premises as the collaborating physician.

I'm guessing / hoping that Ms. Percy cut-and-pasted this from someone else's blurb about the New York proposals. The "current accepted...nursing practice" comment is extremely inappropriate if it in fact came from the offices of the ASA.

 

[toughlife]

I'm guessing / hoping that Ms. Percy cut-and-pasted this from someone else's blurb about the New York proposals. The "current accepted...nursing practice" comment is extremely inappropriate if it in fact came from the offices of the ASA.

Either that or she does not know what's currently accepted practice for CRNAs in NY.

 

[poster]

Hey Ether

Toughlife overe here NEVER underestimate the threat. Listen, he and I have been here on this forum stating this stuff for the last 2+ years. In fact the reason we put together things like the Anesthesiology Club was to provide a physician only forum.

Listen, all of us agree that the PROBLEM is the CRNA. It's not a problem we can downplay anymore. I think where we clash is our solution for the problem. It seems as though you believe AAs are the route to take. I personally believe that the AAs are going to be just as much a threat as CRNA are now. CRNAs did not start off wanting to practice on their own. They were leaches. They worked in the OR with us, did wht we wanted,etc. NOW...they believe they can practice independently. Do you see what we mean? Who is to say that AAs (who do not express a desire to be independent now) will not create the same havoc for us in 10 years that CRNAs do now?

Yes, but AA's from what I understand, do not practice under any other independent source as nursing does. They could never be allowed to practice independently they are required to practice under a anesthesiologist period. So you are making a misleading statement or uninformed one. Just like PA's will never be able to do it independently. So the best option is just as Ether said. Utilize AA's more and work hard to help remove this CRNA independent practice. It is the most feasible option and will buy us some time to come up with something else.

 

[EtherMD]

Yes, but AA's from what I understand, do not practice under any other independent source as nursing does. They could never be allowed to practice independently they are required to practice under a anesthesiologist period. So you are making a misleading statement or uninformed one. Just like PA's will never be able to do it independently. So the best option is just as Ether said. Utilize AA's more and work hard to help remove this CRNA independent practice. It is the most feasible option and will buy us some time to come up with something else.

AA's are part of the solution. A slight reduction of CRNA programs at University Training programs along with a push for about a dozen more AA programs should make a big difference in public perception. The AANA would have something to really worry about: AA's taking jobs away from its members.

The AAAA is an honorable and decent organization that is committed to the ACT model. PA's and AA's will Never have the power of the Nursing Boards behind them. Hence, they will be much more limited in their scope of practice.
The AA is not your enemy; on the contrary, they are the best assistant you can get in the operating room. I will never understand why the establishment doesn't wake up and smell the roses before its too late. People like Volatile need to realize that the window of opportunity to weaken the AANA wont be open forever. The DNAP degree will see to that.

 

[USFgas]

I agree that AA’s are part of the solution. There more of them we can help enter the job market the better.

However, I still believe very strongly, as I have posted several times on this forum, one of the truly viable options open to us is one the AANA has been using so very effectively for some time. PUBLIC AWARENESS!!!

I live in Florida and right off the I95 – one of the busiest Freeways in America - is a billboard stating things like: ‘Having Surgery? Make sure you honestly give your Nurse Anesthetist the information they ask for. It’s very important that your CRNA knows an accurate history. And be sure to ask your CRNA any question you have. Remember, your CRNA is there for you.’

Something along those lines, with a photo of some really intelligent looking guy wearing a surgical mask.

They also run radio spots all over the South East with the same message. ‘Your CRNA is there to help you during one of the most critical times in your life’ ect…..

They are doing everything in their power to make their presence known to the public as the LONE provider in the area of anesthesia.

I believe the ASA needs to do the same thing. A public relations campaign outlining the difference in our training. What is a CRNA? What is an Anesthesiologist? What is the ACT model, and above all, the fact that the patient has the right to know who is giving them their anesthetic?

When a CRNA introduces themselves to patient they often say ‘I’m going to be your anesthetists.’ The patient thinks ‘great’. They’ve got on the right clothes and they look like they know what they’re doing. Many have no idea they are being looked after by a NURSE! They are thinking Doctor!

It will not take much to get the public behind us. A full page ad in USA today. ‘Having Surgery? The American Society of Anesthesiologists would like you to know the following,’ Ect…

If you knew nothing about medicine and you or a loved family member were about to have serious surgery and you went into the hospital knowing about the ACT concept - knowing the major differences between the training an M.D. receives and what a CRNA receives, what would you do? Above all, you now know that the CRNA is NOT the highest level and LONE anesthesia provider in the setting – as it seems the AANA would like the public to believe.

I believe as a profession this is the single most effective weapon available to us, yet the ASA does not want to use it – even though it’s being used very effectively against us.

 

[toughlife]

I agree that AA's are part of the solution. There more of them we can help enter the job market the better.

However, I still believe very strongly, as I have posted several times on this forum, one of the truly viable options open to us is one the AANA has been using so very effectively for some time. PUBLIC AWARENESS!!!

I live in Florida and right off the I95 &#8211; one of the busiest Freeways in America - is a billboard stating things like: &#8216;Having Surgery? Make sure you honestly give your Nurse Anesthetist the information they ask for. It's very important that your CRNA knows an accurate history. And be sure to ask your CRNA any question you have. Remember, your CRNA is there for you.'

Something along those lines, with a photo of some really intelligent looking guy wearing a surgical mask.

They also run radio spots all over the South East with the same message. &#8216;Your CRNA is there to help you during one of the most critical times in your life' ect&#8230;..

They are doing everything in their power to make their presence known to the public as the LONE provider in the area of anesthesia.

I believe the ASA needs to do the same thing. A public relations campaign outlining the difference in our training. What is a CRNA? What is an Anesthesiologist? What is the ACT model, and above all, the fact that the patient has the right to know who is giving them their anesthetic?

When a CRNA introduces themselves to patient they often say &#8216;I'm going to be your anesthetists.' The patient thinks &#8216;great'. They've got on the right clothes and they look like they know what they're doing. Many have no idea they are being looked after by a NURSE! They are thinking Doctor!

It will not take much to get the public behind us. A full page ad in USA today. &#8216;Having Surgery? The American Society of Anesthesiologists would like you to know the following,' Ect&#8230;

If you knew nothing about medicine and you or a loved family member were about to have serious surgery and you went into the hospital knowing about the ACT concept - knowing the major differences between the training an M.D. receives and what a CRNA receives, what would you do? Above all, you now know that the CRNA is NOT the highest level and LONE anesthesia provider in the setting &#8211; as it seems the AANA would like the public to believe.

I believe as a profession this is the single most effective weapon available to us, yet the ASA does not want to use it &#8211; even though it's being used very effectively against us.

Why do we always have to be at the mercy of the ASA and the chairmen who are selling us out?

Why can't we form a group (we can call it American Association of Anesthesiology Residents) and become incorporated in Nevada where you can do it for less than 500 bucks and then start our own advertising campaign.

So how about we stop waiting on the ASA and start doing it ourselves? If that idea were to fly, I would stop my membership and donations to the ASA and donate it to our new organization.

 

[urgewrx]

Why can't we form a group (we can call it American Association of Anesthesiology Residents) and become incorporated in Nevada where you can do it for less than 500 bucks and then start out own advertising campaign.

Can I be the President?


All right buddies, $100 fee to enroll.

 

[Taurus]

Before I went back to medical school, I worked in a cutthroat industry that cared about one thing: profits. Management did whatever it could to make more of it, including outsourcing many of the jobs. If you have ever found yourself in a situation like this, you'd know the feeling. Day after day, you come to work, wondering if the axe will drop on you today. You wonder how you can compete against someone who will get your job on the other side of the globe not because they are more educated or more competent than you but because they are just plain cheaper. It's an unfair fight and that's what anesthesiologists are facing against CRNA's. People who have underestimated the CRNA problem are fooling themselves. Your job and profession as you know it are in great danger. Any time a new threat shows up, you need to take it very seriously. That's the problem with physicians. So many of them are complacent because they believe that they "made it" once they finished medical school and residency; they have this sense of untouchability and the nurses have taken advantage of physicians asleep at the wheel. If you have a business or work in a job with no security, you have the mentality that new threats are constantly on the horizon. If more physicians would have thought this way, CRNA's and midlevels would never exist and become a problem like they are today.

 

[EtherMD]

Before I went back to medical school, I worked in a cutthroat industry that cared about one thing: profits. Management did whatever it could to make more of it, including outsourcing many of the jobs. If you have ever found yourself in a situation like this, you'd know the feeling. Day after day, you come to work, wondering if the axe will drop on you today. You wonder how you can compete against someone who will get your job on the other side of the globe not because they are more educated or more competent than you but because they are just plain cheaper. It's an unfair fight and that's what anesthesiologists are facing against CRNA's. People who have underestimated the CRNA problem are fooling themselves. Your job and profession as you know it are in great danger. Any time a new threat shows up, you need to take it very seriously. That's the problem with physicians. So many of them are complacent because they believe that they "made it" once they finished medical school and residency; they have this sense of untouchability and the nurses have taken advantage of physicians asleep at the wheel. If you have a business or work in a job with no security, you have the mentality that new threats are constantly on the horizon. If more physicians would have thought this way, CRNA's and midlevels would never exist and become a problem like they are today.

There is not a single "newbie" on this board that has a better grasp of the CRNA issue than you. In fact, several CA-3's lack your insight and will need years in private practice to "see" the problem.

There are many private practice guys willing to donate money to a Resident P.R. organization. Through the use of the web and word of mouth the organization could have enough money to start a caveman or chimp commercial in about a year. All you need is someone to incorporate a company and start a web site. Anyone interested? How about you toughlife?

 

[flashgordon]

Here's my question:

If these dumb**** CRNAs want complete independance, does this mean that they will give up their easy 9-5 gig, with no call, working on ASA 1/2 patients? 'Cause if they want the same pay, are they going to work an anesthesiologist's shift, take call, difficult airways, sick patients, and major cases?

I suspect No... they want the same pay but not the same responsibilities. They would like anesthesiologists around as "consultants" to take the hard cases, and save their ass when the **** hits the fan. Absolutley f'ing pathetic.

 

[toughlife]

There is not a single "newbie" on this board that has a better grasp of the CRNA issue than you. In fact, several CA-3's lack your insight and will need years in private practice to "see" the problem.

There are many private practice guys willing to donate money to a Resident P.R. organization. Through the use of the web and word of mouth the organization could have enough money to start a caveman or chimp commercial in about a year. All you need is someone to incorporate a company and start a web site. Anyone interested? How about you toughlife?

Here's the website with the forms we need to incorporate and start an organization. It can be non-profit and designated as a professional medical organization with the purpose to inform the public about issues concerning their health. We will definitely need officers and it'd be great to have those of you at the attending level provide guidance.

http://secretaryofstate.biz/comm_rec/crforms/domestic_index.htm


I mentioned nevada because it's easy and cheap to do it there. It doesn't have to be there but I just wanted to get the idea floating. I can file the paperwork but I will need help with the website since I am not very tech savvy.

 

[Planktonmd]

Here's the website with the forms we need to incorporate and start an organization. It can be non-profit and designated as a professional medical organization with the purpose to inform the public about issues concerning their health. We will definitely need officers and it'd be great to have those of you at the attending level provide guidance.

http://secretaryofstate.biz/comm_rec/crforms/domestic_index.htm


I mentioned nevada because it's easy and cheap to do it there. It doesn't have to be there but I just wanted to get the idea floating. I can file the paperwork but I will need help with the website since I am not very tech savvy.

Go for it guys

 

[USFgas]

I think this a great start. However, we will need more than just a few people sending $100 to make this work. It would need to involve hundreds of people, if not thousands, who truly understand the battle in which we are about to engage.


If we go the advertising campaign route we will also need the following:

1. An attorney to go over the final ads to make certain we don’t open ourselves up to lawsuits from the AANA.
2. A professional PR organization to help with cost effective radio and print spots.
3. A contact person to register names of those interested – we can’t do this anonymously on this forum. (All persons need to be registered with the ASA – it would be imperative that no CRNA get into the group. So we need a person responsible for vetting each potential group member.)

These are just some basics of a ‘Do it yourself’ movement.

Another idea we could get behind is a massive letter writing campaign to the ASA stating that this is what we want to see, and if they don’t respond we would consider organizing a group to do this ourselves. It is unlikely, but the best thing is to get the ASA behind this idea.

Also, does anyone know how to get the email address of all members of the ASA? After all, how many people really read this forum? If this concept is to be taken seriously, perhaps our initial efforts should not be towards forming our own group to start this project. Perhaps our task would be to start a campaign simply getting in touch with the ASA membership asking for their participation. The more we get behind the idea, the better.

Lastly, an idea that would not get anyone in legal trouble – I believe. I’m certain you’ve all heard of UTUBE. Have you seen the unapproved political ads? Because of the medium politicians are allowed to state whatever they want without the ‘this message was approved by’ ect… We also see some independent spots that are very provocative that can’t be touched. It would not get as much attention as a full page ad in USA Today, but it’s a start.

We can complain it all we want here, but are we really ready to take some action? If so, how many?

Let’s start with this. ALL people willing to investigate this further send me a PRIVATE message using only your screen name for the moment. I will wait a few days and report back how many names have responded.

 

[urgewrx]

I think this a great start. However, we will need more than just a few people sending $100 to make this work. It would need to involve hundreds of people, if not thousands, who truly understand the battle in which we are about to engage.

We also need infalible outcome studies, preferably in the New England Journal.

 

[USFgas]

We also need infalible outcome studies, preferably in the New England Journal.

Urgewrx, you most certainly have my vote for president. I think it speaks volumes that you are the first person to step up the plate.

However, I do not think studies of any kind are needed. This is not about outcome statistics; it’s about the difference in levels of training, and doing something to help the public understand this fact. Also, helping them understand the AANA agenda. They are not thinking about what’s best for patent care – they are working to expand their careers through political lobbying and running their own PR campaign. They are winning the PR campaign in a major way simply because the ASA refuses to engage.

Someone posted that the older guys don’t really care because their money is made and by the time this comes to a head they’ll be gone. For the most part I believe this. Any resident or new attending has a threatened future because of the full-throttled approach of the AANA to become the lone anesthesia providers in the U.S. Once the weight of this battle is too much to their side, and they become universally accepted by both the public and the government, the fight will be over.

As a large group of professionals I believe could we win this fight with the PR campaign being discussed here. It’s a simple equation: When your life, or the life of a loved one is on the line during a serious surgery, who would you want holding the scalpel? Who would you want giving the anesthetic – the best that’s who. The one with the most intense training.

This is an easy concept to understand for any member of the public. However, regarding our profession right now the only voice they are hearing, and on a mass level, is that of the AANA.

 

[toughlife]

I think this a great start. However, we will need more than just a few people sending $100 to make this work. It would need to involve hundreds of people, if not thousands, who truly understand the battle in which we are about to engage.


If we go the advertising campaign route we will also need the following:

1. An attorney to go over the final ads to make certain we don’t open ourselves up to lawsuits from the AANA.
2. A professional PR organization to help with cost effective radio and print spots.
3. A contact person to register names of those interested – we can’t do this anonymously on this forum. (All persons need to be registered with the ASA – it would be imperative that no CRNA get into the group. So we need a person responsible for vetting each potential group member.)

These are just some basics of a ‘Do it yourself’ movement.

Another idea we could get behind is a massive letter writing campaign to the ASA stating that this is what we want to see, and if they don’t respond we would consider organizing a group to do this ourselves. It is unlikely, but the best thing is to get the ASA behind this idea.

Also, does anyone know how to get the email address of all members of the ASA? After all, how many people really read this forum? If this concept is to be taken seriously, perhaps our initial efforts should not be towards forming our own group to start this project. Perhaps our task would be to start a campaign simply getting in touch with the ASA membership asking for their participation. The more we get behind the idea, the better.

Lastly, an idea that would not get anyone in legal trouble – I believe. I’m certain you’ve all heard of UTUBE. Have you seen the unapproved political ads? Because of the medium politicians are allowed to state whatever they want without the ‘this message was approved by’ ect… We also see some independent spots that are very provocative that can’t be touched. It would not get as much attention as a full page ad in USA Today, but it’s a start.

We can complain it all we want here, but are we really ready to take some action? If so, how many?

Let’s start with this. ALL people willing to investigate this further send me a PRIVATE message using only your screen name for the moment. I will wait a few days and report back how many names have responded.

Email addresses of ASA members can be found in the members page under directory.

If you want to keep this from the public, the private forum is also a good venue.

 

[urgewrx]

I cannot log-in on the private forum, BTW.
​

 

[me454555]

If we do blocks, they learn blocks. If we do pain, they learn pain. If we subspecialize, they'll subspeciallize.

We get clock radios, nurses can't afford clock raidos. Borat big success

 

[me454555]

Public campaigning is definatly the most effective way to go. Even when I explain to my friends, what an anesthesiologist does, most of them go "really? I thought that was the surgeon". The problem isn't so much the nurses, its more to do w/the perceptions of what we do and don't do. Most lay persons see us as the docs who put you under and wake you up. They don't know all the things we do during the case or before the case. This is the problem. Shows like grey's anatomoy certianly don't help our image either. Its always the surgeons who are taking care of the vitals, ordering fluids, and running the codes. We need to educate the public on what exactly it is that we do. If we can do this, there should be no doubt that a physican is needed to do this job independantly and not a nurse.

Another prong of attack should be to try to change the law so that only an anesthesiologist can supervise CRNAs. This is much easier said than done but as pointed out by others on this forum, it really is common sense.

 

[toughlife]

I cannot log-in on the private forum, BTW.
​

Did you send me your ASA #?

 

[toughlife]

Public campaigning is definatly the most effective way to go. Even when I explain to my friends, what an anesthesiologist does, most of them go "really? I thought that was the surgeon". The problem isn't so much the nurses, its more to do w/the perceptions of what we do and don't do. Most lay persons see us as the docs who put you under and wake you up. They don't know all the things we do during the case or before the case. This is the problem. Shows like grey's anatomoy certianly don't help our image either. Its always the surgeons who are taking care of the vitals, ordering fluids, and running the codes. We need to educate the public on what exactly it is that we do. If we can do this, there should be no doubt that a physican is needed to do this job independantly and not a nurse.

Another prong of attack should be to try to change the law so that only an anesthesiologist can supervise CRNAs. This is much easier said than done but as pointed out by others on this forum, it really is common sense.

 

[toughlife]

Here's an example of how aggressive the CRNAs are tooting their horn. We need to beat that.


I think it is a quantum leap to go from bedside nursing to advancing the science of anesthesia, but so goes their thinking.

 

[Taurus]

To me, our natural and most powerful ally are the surgeons. We need to convince them to always request anesthesiologists managing the anesthesia. We can start by explaining to them how they're exposing themselves to increased liability if they use solo CRNA's.

Insurance companies need to be informed that they need to increase their premiums for solo CRNA's because they represent a higher risk.

Lawyers need to be informed that they should pursue solo CRNA's as aggressively as anesthesiologists.

The nurses took their gloves off. We have to too.

 

[FSUCRNA]

Here's an example of how aggressive the CRNAs are tooting their horn. We need to beat that.


I think it is a quantum leap to go from bedside nursing to advancing the science of anesthesia, but so goes their thinking.

Great AD! The AANA knows how to do marketing well. Some of us can't wait until the marketing begins for the Doctor of Nurse Anesthesia . There is plenty of room in the USA for all us "Doctors" of anesthesia, right?

 

[FSUCRNA]

To me, our natural and most powerful ally are the surgeons. We need to convince them to always request anesthesiologists managing the anesthesia. We can start by explaining to them how they're exposing themselves to increased liability if they use solo CRNA's.

Insurance companies need to be informed that they need to increase their premiums for solo CRNA's because they represent a higher risk.

Lawyers need to be informed that they should pursue solo CRNA's as aggressively as anesthesiologists.

The nurses took their gloves off. We have to too.

Shows how desperate you are by threatening lawyers on us. I guess if you can't beat us fair and square call the lawyers. As for premiums if they go up we will pay them.

 

[toughlife]

Shows how desperate you are by threatening lawyers on us. I guess if you can't beat us fair and square call the lawyers. As for premiums if they go up we will pay them.

He is just returning the favor.

 

[somedumbDO]

Great AD! The AANA knows how to do marketing well. Some of us can't wait until the marketing begins for the Doctor of Nurse Anesthesia . There is plenty of room in the USA for all us "Doctors" of anesthesia, right?

hell you can call your selfs anything you want, "grand wizard of nursing doctor anesthetist", but at the end of the day all your colleagues know who you really are, a nurse. Its like the rapper, Dre calls himself "doctor" too but I wont go see him to have my gallbladder removed. Beside with nationalized health care inching ever so closely to the US. There will be a two partied system. This is evident with EVERY country that has nationalized health care. The government health care consisting of residents/mid levels and the Private sector consisting of MD/DO, and I don't think the government is going to pay a nurse 6 figures. If you honestly think that maybe you should ask what VA docs/nurses make!!! But the private sector...... you know they usually pay what your really worth.

capitalism is great huh?

SDD

 

[FSUCRNA]

Well,

We aren't socialized yet so I am happy with what the market pays me.
I make great money working solo and run my own anesthesia show.
I have a Masters but will get the Doctor title once a school in my area offers it. Loving Anesthesia and my current situation

 

[Planktonmd]

Great AD! The AANA knows how to do marketing well. Some of us can't wait until the marketing begins for the Doctor of Nurse Anesthesia . There is plenty of room in the USA for all us "Doctors" of anesthesia, right?

When I see someone like you using this type of language, it makes me regret every time I taught a CRNA something or held their hand and helped them evolve, and God knows I have done that countless times.
You, my friend, and the young aimless new CRNA's like you, are the main reason why this field of medicine is in danger.
Before you call yourself a doctor or pretend to be a scientist you need to learn to behave like one.
I usually don't address CRNA's on this forum but I am making it an exception because you were beyond offensive and ill-mannered.
You need to look at yourself in the mirror and stop lying to yourself, you will always be a nurse and you need to be proud of it.

 

[FSUCRNA]

When I see someone like you using this type of language, it makes me regret every time I taught a CRNA something or held their hand and helped them evolve, and God knows I have done that countless times.
You, my friend, and the young aimless new CRNA's like you, are the main reason why this field of medicine is in danger.
Before you call yourself a doctor or pretend to be a scientist you need to learn to behave like one.
I usually don't address CRNA's on this forum but I am making it an exception because you were beyond offensive and ill-mannered.
You need to look at yourself in the mirror and stop lying to yourself, you will always be a nurse and you need to be proud of it.

I was just kidding around. I am proud of being a Nurse and ALWAYS tell my patients I am a CRNA. I have learned a lot from MDA's and senior CRNA' so I am grateful. But, after more than 5,000 anesthetics I am proud to be doing my own thing.

 

[toughlife]

Great AD! The AANA knows how to do marketing well. Some of us can't wait until the marketing begins for the Doctor of Nurse Anesthesia . There is plenty of room in the USA for all us "Doctors" of anesthesia, right?

The ad is great to show the web of deceit and lies that your organization is good at creating.
Your mockery serves as a great example for all anesthesiology residents and attendings in this forum to show that no one should be fooled by CRNAs for one second.

Keep posting as we love to see your true colors and show everyone here how cunning and full of **** all CRNAs are.


To all of the attendings and residents who waste their time teaching these people anything, here's your reward.

Stop being fooled and see things for what they really are.

 

[FSUCRNA]

The ad is great to show the web of deceit and lies that your organization is good at creating.
Your mockery serves as a great example for all anesthesiology residents and attendings in this forum to show that no one should be fooled by CRNAs for one second.

Keep posting as we love to see your true colors and show everyone here how cunning and full of **** all CRNAs are.


To all of the attendings and residents who waste their time teaching these people anything, here's your reward.

Stop being fooled and see things for what they really are.

I am very greatful to MD/DO Anesthesiologists for teaching me a great deal at my CRNA program. I trained at a top ten CRNA school that was University based. MD's and senior CRNA's taught me a ton and I learned well. After working under MD supervision for 5 years I decided to do my own thing. I now earn a great living and do the anesthesia solo. Most MD's were smart and great to work with but a few were a total waste of time. Now, I don't have to put up with anyone else telling me what to do except the surgeon.
I like it that way.

I admit that I am in the minority of CRNA's but the AANA gave me the choice to practice solo. I appreciate that and support the AANA along with most CRNA's. Once we get sufficient experience we should be allowed to work solo and compete for jobs. This is the American way and most of the solo work we do is not wanted by an MD. The doctorate degree is more proof we should be allowed to work independently.
We fill the void and sometimes get a great gig at an outpatient center or plastic surgeon's office.

 

[toughlife]

The "doctorate degree" is the next gimmick to fool patients and make them think you are what you really aren't!

And do me and favor and take all your niceties and "nice" misdemeanor and put them where the sun does not shine.

 

[somedumbDO]

Well,

We aren't socialized yet so I am happy with what the market pays me.
I make great money working solo and run my own anesthesia show.
I have a Masters but will get the Doctor title once a school in my area offers it. Loving Anesthesia and my current situation

If you are so proud of being a CRNA why get the doctor title?? That doesn't make sense, will it make you more competitive in the job market? not really (at this current point in time, yes maybe in the FAR DISTANT future). Will it make you a better clinician?? no (your clinical work will do that, not your title). What benefit that you will realize in your professional life by being a CRDA or whatever they are going to call them?? The only reason I can surmise is that you really just want to be a, "DOCTOR". Why do you feel like you need to compete/be equal with MD/DO's if not for an inferiority complex?? You are a nurse that practices anesthesia, and i am sure you are proficient in your abilities. If you want to be a doctor that practices anesthesia become one, put the time in and really be devoted to your craft. Dont try and use semantics to justify your situation. Especially go on to a MD/DO board and post inflammatory remarks to individuals that are the reason you are doing your craft now.

This is the REAL problem with CRNA/Nursing in general. The majority of nurses I have/do worked with are awesome. They do there job they are great at it. They do things that I don't know how to do. I thank them for there help every day. But its the minority of nurses for whatever reason think that they should be both doctor and nurse. They have a superiority complex second to none. They believe that they are the end all solution to medicine. Its preposterous!!! not to mention dangerous to the patient!! Just because you watch doctors do a craft and you emulate them doesnt mean that can do there whole job. Just like I cannot watch a couple of law shows and think that I can try a legal case.

 

[FSUCRNA]

If you are so proud of being a CRNA why get the doctor title?? That doesn't make sense, will it make you more competitive in the job market? not really (at this current point in time, yes maybe in the FAR DISTANT future). Will it make you a better clinician?? no (your clinical work will do that, not your title). What benefit that you will realize in your professional life by being a CRDA or whatever they are going to call them?? The only reason I can surmise is that you really just want to be a, "DOCTOR". Why do you feel like you need to compete/be equal with MD/DO's if not for an inferiority complex?? You are a nurse that practices anesthesia, and i am sure you are proficient in your abilities. If you want to be a doctor that practices anesthesia become one, put the time in and really be devoted to your craft. Dont try and use semantics to justify your situation. Especially go on to a MD/DO board and post inflammatory remarks to individuals that are the reason you are doing your craft now.

This is the REAL problem with CRNA/Nursing in general. The majority of nurses I have/do worked with are awesome. They do there job they are great at it. They do things that I don't know how to do. I thank them for there help every day. But its the minority of nurses for whatever reason think that they should be both doctor and nurse. They have a superiority complex second to none. They believe that they are the end all solution to medicine. Its preposterous!!! not to mention dangerous to the patient!! Just because you watch doctors do a craft and you emulate them doesnt mean that can do there whole job. Just like I cannot watch a couple of law shows and think that I can try a legal case.

If a school in my area offers a DNAP then I plan on getting it. The AANA recommends every CRNA get a DNAP. I plan on teaching at a CRNA school in 10-15 years so I will need the DNAP.

The LAW allows me to practice solo. The surgeons I work with know the situation. I do a good job and they appreciate it. I am not an MD and never claimed to be. I am proud member of the AANA and a happy Independent CRNA.

 

[me454555]

If a school in my area offers a DNAP then I plan on getting it. The AANA recommends every CRNA get a DNAP. I plan on teaching at a CRNA school in 10-15 years so I will need the DNAP.

The LAW allows me to practice solo. The surgeons I work with know the situation. I do a good job and they appreciate it. I am not an MD and never claimed to be. I am proud member of the AANA and a happy Independent CRNA.

What happens when you get into trouble? I don't mean the legal kind, I mean when a pt starts crunking and you don't know what to do? Does the surgeon chime in and help you out? I doubt they know more about anesthesia than you do. Who do the lawyers go after in this case? You or the surgeon?