dealing with CRNAs

[BLADEMDA]

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Yes - happened to me too.
The only way to deal with an issue like this is to avoid this type of conversations.
You are at another level. I understand the CRNA's too - they aren't bad people overall. They try to make some money and they fell that the political and economical atmosphere it is in their favor.
I said a while ago that the AANA it is a terrorist organization and I maintain this view.
The only way to demonstrate that we are way better is to REALLY BE better.
Be the bet one in regional, peds, heart, ccm.
The value is recognized and it will be seen in your paycheck.
Forget the CRNA and focus,,,,,
2win

Agree 100%.👍👍👍👍👍

 

[eosinophilic]

Maybe its different because I work only in the pediatric world now-- but I have great respect for most of my nurse colleagues-- particularly those CRNAs that do mostly/only peds, my PICU nurse practitioner colleagues, and PICU nurses. They bring a lot to the table, and know their limitations. They defer to their physician colleagues/supervisors when it's appropriate and ask questions when it's appropriate. There is no ego, "I'm just as well-trained as you" stuff.

I have major issues with stereotyping an entire nursing profession- granted I am well aware that not everyone agrees with the likes of FuturrENT-- but there is a role for nurses out there when they practice within the realm that they were intended to. For you med students and early stage residents-- please don't make assumptions about the CRNA's, NPs and nurses that you come across in your day to day interactions. There are some excellent ones and (gasp!) some you can learn from. I know it's cool on this board to hate on CRNAs, but assess each one individually and don't become one of "those" folks who just hates on a group of people who you think are inferior just because they didn't go to school as long as you.

Not sure if this was in response to my post or not but dont get me wrong...I appreciate nurses (like I said my wife is a nurse so I know where theyre coming from) and respect all of them. Its only when they f up that Ill say anything to them and always respectfully (happened twice in my four months of residency). ARNP's pretty much function as fellows and upper level residents at my institution...but I stand by my statement about nurses being taught from the start that they are independent of doctors and how this can lead to a certain mindset amongst a certain subset of nurses.

 

[michigangirl]

wasn't intended toward you at all-- like I said, I agree with many of the responses to my post, and certainly this educational approach is making it easier for certain nurses to feel more comfortable/confident/independent than they should.

Not sure if this was in response to my post or not but dont get me wrong...I appreciate nurses (like I said my wife is a nurse so I know where theyre coming from) and respect all of them. Its only when they f up that Ill say anything to them and always respectfully (happened twice in my four months of residency). ARNP's pretty much function as fellows and upper level residents at my institution...but I stand by my statement about nurses being taught from the start that they are independent of doctors and how this can lead to a certain mindset amongst a certain subset of nurses.

 

[deansrv72]

Here's how you handle that situation. Rehearse this response, and then feel free to use it (or some variation thereof) ad libitum:

"Okay, nice. It's so great you are well-read. Here's something I hope you can help me clarify. I've read in Stoelting that phenylephrine is primarily a venoconstrictor acting in the vascular beds, and serves mostly to increase pre-load. But, Barash says it has a mixed effect on arterioles and venules, increasing both pre-load AND afterload. Still, Mikhail & Morgan isn't really clear where the primary mechanism of action occurs. Also, none comments about how it's broken down, whether it is through catechol-o-methyltransferase, monoamine oxidase through cellular uptake, some non-specific plasma esterase or some other degradation pathway. Since we use this drug pretty much every day, I'm sure you've thought about this too and have an answer, right?"

Now, you may get all variety of answers from, "I don't know" to "That's not important in the 'real world' when you get out into private practice" to "Are you mocking me?" or even some attempt at a bona fide answer. No matter what she says, your only response should be...

"Oh... I'm surprised to hear you say that."

And, then say nothing else.

You can't approach her now and do this, though. Be patient. Don't seek her out. Wait for a similar situation and then drop this on her. If that doesn't shut her up, nothing will.

Best of luck!

-copro

So, you're able to answer every question you posed, and without looking up anything prior to your response? Not many are COMT proficient off the bat. Thus, I'm no believer.

 

[deansrv72]

Interesting point blade-- in the true definition it seems colleague is not the appropriate term-- my fellow "team members?"

And I completely agree to all the other responders to my comments-- I for one am totally on board with the agenda that we as anesthesiologists need to uphold and defend in order to maintain and advance our profession as it deserves. You can imagine, as a peds anesthesiologist, how I shudder at the thought of CRNAS practicing independently and being given the power to induce anesthesia without a physician's supervision. That is ridiculous. It is true that it is the militant, overpowering CRNAs that push these agendas that concern all of us.

My reply was intended for all the young grasshoppers out there who are jumping on a bandwagon they don't know enough about. Making uneducated judgments without perspective. Treating an entire group of people early in your career like they are just not worth being respected. Those of us who have been around a while know what battles to pick, and how to play the game of being nice as needed to get through the day-- and when you shouldn't be nice. . I've seen how some surgeon types come into my PICU and talk to my nurse practitioners-- as though they are a bug that needs to be squashed. But that same nurse practitioner caught some ridiculous dosing error that they made in a chronic kids meds, and on and on and on. Same goes for how some surgeons treat some of our CRNAs-- even if they've proven themselves over a long time to be excellent anesthesia providers under the supervision of a physician. Be humble at the beginning and be respectful until you figure out they don't deserve it. Don't burn bridges so quickly in your career-- it's not in your best interest.

I'm curious as to why you shudder at the fact that CRNAs can (and do) proceed, from start to finish, without an anesthesiologist. I'm not here to flame, but this goes on all the time, everyday, everywhere, without incident. Shudder? C'mon.

 

[jwk]

So you resurrected a three year-dead thread for this drivel?

 

[BuzzPhreed]

So, you're able to answer every question you posed, and without looking up anything prior to your response? Not many are COMT proficient off the bat. Thus, I'm no believer.

This is basic training in medical school pharmacology. Every anesthesiologist knows this or has learned this at one point in their training. That's the difference. And, yes, sometimes it matters. That's what the poster was trying to convey. CRNAs often only learn what, when and how and at least the ones I work with do much of what they do by rote ("this is how you do this case... this is how you do that case...) and can get away with it most of the time without a deeper understand of the why. Read Robert Loblaws post. He gets it. And that's the distinction.