Dr. Nurse

[matt1234321]

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Is it true that by the year 2015 all midlevel nuses will be required a doctorate?
If so, I think this is an attempt to again increase the public perception of nurses and further expand the midlevel's scope of practice. If this happens we'll have direct competition in all fields as it is in anesthesia.

 

[matt1234321]

Hell, not to mention anesthesia will be the first to get hit hard on this one, I think. Since the crna's are already reimbursed at almost at 90% for solo casework.

 

[Monty Python]

Is it true that by the year 2015 all midlevel nuses will be required a doctorate?
If so, I think this is an attempt to again increase the public perception of nurses and further expand the midlevel's scope of practice. If this happens we'll have direct competition in all fields as it is in anesthesia.

The council of advanced practice nurses (whatever the official name) which represents CRNAs, FNPs, midwives, and a few other areas decided that all advanced nursing educational programs must be doctorally-based by 2015.

It can be research-based (PhD with dissertation 😴 ), or clinical-based (DNP).

Initially the Am. Assoc. of Nurse Anesthetists was against the idea, seeing no real value, only increased educational time and cost to obtain a degree entitling you to argue how many angels can dance on the head of a pin. But the other specialty areas were strongly in favor of the idea, so the AANA chose to not fight a battle it couldn't win and just went along with the majority.

Many many CRNAs are furious about this RIDICULOUS idea.

This will also demonstrate the Law of Unintended Consequences: my state's Board of Nursing has final oversight over all nursing educational programs. I assume this is similar to one degree or another in all states. My state's BON regulations require the majority of a particular degree's faculty to possess the same (or higher) degree as the one being granted. Meaning, to grant the CRNA doctorate, the CRNA educational program must now somehow recruit and retain doctorally-prepared faculty. Guess what .... they're not out there waiting to be recruited. They don't exist. 🙄

 

[jwk]

Fortunately, scope of practice is determined by the individual states legislatures and/or boards of nursing, not professional organizations. Absent legislation or formal regulation, the dr./nurse thing means nothing. I think most non-nurses see it as a blatant attempt to confuse patients and it offers no real advanced clinical training.

The AMA, ASA, and others are already working hard in this area. There is also proposed federal legislation addressing this very issue and it has been discussed ad nauseum on the practioner's section of SDN.

 

[matt1234321]

The council of advanced practice nurses (whatever the official name) which represents CRNAs, FNPs, midwives, and a few other areas decided that all advanced nursing educational programs must be doctorally-based by 2015.

It can be research-based (PhD with dissertation 😴 ), or clinical-based (DNP).

Initially the Am. Assoc. of Nurse Anesthetists was against the idea, seeing no real value, only increased educational time and cost to obtain a degree entitling you to argue how many angels can dance on the head of a pin. But the other specialty areas were strongly in favor of the idea, so the AANA chose to not fight a battle it couldn't win and just went along with the majority.

Many many CRNAs are furious about this RIDICULOUS idea.

This will also demonstrate the Law of Unintended Consequences: my state's Board of Nursing has final oversight over all nursing educational programs. I assume this is similar to one degree or another in all states. My state's BON regulations require the majority of a particular degree's faculty to possess the same (or higher) degree as the one being granted. Meaning, to grant the CRNA doctorate, the CRNA educational program must now somehow recruit and retain doctorally-prepared faculty. Guess what .... they're not out there waiting to be recruited. They don't exist. 🙄

If you think about it, it might help all anesthesia providers to make a higher salary. If it means less crnas, the supply drops and demand rises. I guess we'll just have to wait and see.

 

[Conflicted]

Hmmm

I think its senseless. If people want to get a doctorate (PhD) they can do it post grad.

Any RN who was doctorate prepared should NEVER call themselves "DOCTOR" in a medical setting. They should simply jhave the PhD or DnP after their names.

 

[rn29306]

Initially the Am. Assoc. of Nurse Anesthetists was against the idea, seeing no real value, only increased educational time and cost to obtain a degree entitling you to argue how many angels can dance on the head of a pin. But the other specialty areas were strongly in favor of the idea, so the AANA chose to not fight a battle it couldn't win and just went along with the majority.

Many many CRNAs are furious about this RIDICULOUS idea.

We are getting dragged kicking and screaming on the hopes and the dreams of the NPs by this deal. Trin I knew that earlier this year the AAN put out a position statement concerning this and was esentially was politicalspeak for 'we don't want this' but I figured that we would have to conceed to the overall group opinion.

I have met NO CRNA that wants this for alot of reasons. It also makes nursing, in my opinion, look like a bunch of assmonkeys. The whole Dr Nurse thing is ridiculus. It adds nothing to the S of P for CRNAs and adds no benefits that I can see. Also, I agree with Conflicted......not saying this to win favor of any of you or kiss up.....but "dr" should, in a clinical scenario, be reserved for MD/DO only. If someone wants to have a doctorate, then by all means. Just don't call yourself that in a clinical setting. I loved busting non-physician proclaimers of the doctorate in my previouis hospital and told them so....Same with white coats, but no one listens to me for ****. I'm secure in my role and don't need to cloud issues by running around proclaiming this "dr' bull****.

F'ing ridiculus.

 

[VolatileAgent]

If it means less crnas, the supply drops and demand rises.

it doesn't mean less crnas. as others have pointed out, this is essentially semantics.

let's make this clear: there is currently a shortage of anesthesia providers at all levels of training. until that changes, the current situation will not change drastically. with more crna schools opening, there will be more crnas on the job market. with reimbursements structured the way they are, this means more crnas will be relegated to non-blue-chip cases (ie. where they have to "share" a portion of the reimbursement on low-payer cases, namely medicare/medicaid). it's a bad situation for crnas that will not get any better, even if they enact this proposed plan and require "doctorate" level training for all mid-levels.

remember, this is doctorate of nursing practice, not medical doctor equivalency. in other words, may mean something for perception of authority but nothing on actual authority.

 

[Conflicted]

VA


This is where we agree. Just to say it out loud, a "Doctor of Nursing practice" is total BS. I would further respect someone of any profession who went on and did a PhD, but I think this "DnP" is a total joke.

I don't care if they decide to go ahead and force it to happen, but i will NEVER call anyone but an MD/DO "Doctor" in a medical setting.

it doesn't mean less crnas. as others have pointed out, this is essentially semantics.

let's make this clear: there is currently a shortage of anesthesia providers at all levels of training. until that changes, the current situation will not change drastically. with more crna schools opening, there will be more crnas on the job market. with reimbursements structured the way they are, this means more crnas will be relegated to non-blue-chip cases (ie. where they have to "share" a portion of the reimbursement on low-payer cases, namely medicare/medicaid). it's a bad situation for crnas that will not get any better, even if they enact this proposed plan and require "doctorate" level training for all mid-levels.

remember, this is doctorate of nursing practice, not medical doctor equivalency. in other words, may mean something for perception of authority but nothing on actual authority.

 

[dr. mccoy]

If the nurses who achieve their doctorate become Dr. Nurse (i.e.independent practitioners), does that mean that us doctors, who continue to lose our practice to these "pseudo physicians", will ourselves become Nurse Drs.?

 

[cfdavid]

I think we all agree that this Dr. Nurse thing is just totally ridiculous. It's almost like, at what point does the madness end...?

I'm all for advanced education, but this is getting kind of silly. If you want to be a doctor in clinical medicine, go to medical school. But that would make too much sense, I guess.

 

[matt1234321]

it doesn't mean less crnas. as others have pointed out, this is essentially semantics.

let's make this clear: there is currently a shortage of anesthesia providers at all levels of training. until that changes, the current situation will not change drastically. with more crna schools opening, there will be more crnas on the job market. with reimbursements structured the way they are, this means more crnas will be relegated to non-blue-chip cases (ie. where they have to "share" a portion of the reimbursement on low-payer cases, namely medicare/medicaid). it's a bad situation for crnas that will not get any better, even if they enact this proposed plan and require "doctorate" level training for all mid-levels.

remember, this is doctorate of nursing practice, not medical doctor equivalency. in other words, may mean something for perception of authority but nothing on actual authority.

I wouldn't under estimate public perception because it plays an important role in policy making. However, this wont effect anesthesia until 2019.

 

[huron]

I think we all agree that this Dr. Nurse thing is just totally ridiculous. It's almost like, at what point does the madness end...?

I'm all for advanced education, but this is getting kind of silly. If you want to be a doctor in clinical medicine, go to medical school. But that would make too much sense, I guess.

Where Did Conflicted go?


I was listing to the radio and just heard a AANA commercial disguised as a public service message.
It implied that CRNAs are the only anesthesia providers and warns the listeners to be honest with your CRNA about your health history next time you are scheduled to have surgery.

 

[matt1234321]

When I was younger my tonsils were taken out and I was anesthetized by a nurse. At the time I had no idea this was a job that physicians do as well. I think most people are ignorant of this issue, as was I.

 

[VolatileAgent]

Where Did Conflicted go?

http://gasforums.studentdoctor.net/showthread.php?t=353895

 

[matt1234321]

get a load of this. lol

This is the second time I have come across a nurses job under physicians job search.

http://www.munsonhealthcare.org/cgi...anRecruitDA/DisplaySpecialty?uniqueid=1000103

 

[VolatileAgent]

yeah, and who the hell wants to live in traverse city. you have about one pleasant month out of the year up there.

 

[GasEmDee]

I loved busting non-physician proclaimers of the doctorate in my previouis hospital and told them so....Same with white coats, but no one listens to me for ****. I'm secure in my role and don't need to cloud issues by running around proclaiming this "dr' bull****.

F'ing ridiculus.

Yeah, totally. I always thought it was pretty shady in medical school when an MD/PhD student who had just completed a PhD referred to him- or herself on the wards as Dr. so and so on .... Yes, technically they have a doctoral degree, but in the context of clinical care, that title implies so much more.

 

[matt1234321]

these issues can all be easily resolved with a military style dress codes and forced titles on badges. Every patient would know exactly who is what.

1. Doctors have to wear white coats

2. Nurses have to wear red scrubs

3. housekeeping has to wear black and white maid costumes lol

4. WAIT, no, SWITCH #3 with #2 LOL

 

[sallyjoe]

these issues can all be easily resolved with a military style dress codes and forced titles on badges. Every patient would know exactly who is what.

1. Doctors have to wear white coats

2. Nurses have to wear red scrubs

3. housekeeping has to wear black and white maid costumes lol

4. WAIT, no, SWITCH #3 with #2 LOL

If you have practiced with CRNAs you will see that they act like doctors in front of patients and the vast majority of the patients do not know who is doing their anesthesia.

I was practicing in teaching hospital and a new attending, a full professor who had left another teaching hospital, first complaint was that the CRNAs and the resident were calling him by his fist name and not affording him the respect he disserved by calling him doctor. This never bothered me but if you watch the CRNAs they will introduce themselves by their first name and introduce you the same way so the patient will not know who is the doctor or that they are under the anesthetic care of a nurse. However, The CRNA do afford the Surgeons the courtesy of being called doctor.

The only way to inform the public would be to have the CRNAs wear their nurses hats in front of patients.

 

[matt1234321]

If you have practiced with CRNAs you will see that they act like doctors in front of patients and the vast majority of the patients do not know who is doing their anesthesia.

The only way to inform the public would be to have the CRNAs wear their nurses hats and the old fashioned nurses uniform in front of patients.

I think thats what i was getting at. that is not a bad idea. lol

 

[VolatileAgent]

...but if you watch the CRNAs they will introduce themselves by their first name and introduce you the same way so the patient will not know who is the doctor or that they are under the anesthetic care of a nurse.

if this bothers you (doesn't me), then when you're introduced to the patient by your first name by the crna, re-introduce yourself by saying, "hi, i'm dr. so-and-so" when you shake their hand. the point will be made. of course, we don't share cases with crna's at my institution. so, i've never seen this scenario happen.

 

[foxtrot]

If you have practiced with CRNAs you will see that they act like doctors in front of patients and the vast majority of the patients do not know who is doing their anesthesia.

I was practicing in teaching hospital and a new attending, a full professor who had left another teaching hospital, first complaint was that the CRNAs and the resident were calling him by his fist name and not affording him the respect he disserved by calling him doctor. This never bothered me but if you watch the CRNAs they will introduce themselves by their first name and introduce you the same way so the patient will not know who is the doctor or that they are under the anesthetic care of a nurse. However, The CRNA do afford the Surgeons the courtesy of being called doctor.

The only way to inform the public would be to have the CRNAs wear their nurses hats in front of patients.

At my residency program, I have seen with my own eye's, CRNAs walking around wearing long white coats and introducing themselves by their first name and saying that they are going to be the patient's anesthesia provider. Or they will be working with an SRNA student and do this. Many of them don't say they are a nurse anesthetist. And of course the patients think they are a doctor. The overwhelming majority of patients don't know. Hell, if I wasn't in anesthesia, I probably wouldn't know the difference. I think that this kind of thing may be more of a problem in academic centers that train residents and have a CRNA school as well. Maybe private practice is different but it still is ridiculous. And the sad thing is, we as a profession have allowed the AANA to become this powerful. So we really have no one to blame but ourselves. So we, ourselves, have to start making some changes to distinguish ourselves as physicians.

 

[bigdan]

1) Long coats are now so ubiquitous that they mean nothing; the "clinical assistants" (or whatever you call the OR cleaners) even have them at my hospital, and wear them with pride to the caf, bank, wherever. Only one rank is obvious - that of the short-coated medical student.

2) Why no ad campaign? I don't mean "A CRNA can't do the work...", because we know they can. But why not a dignified "Know your provider..." style ad? Why not?

dc

 

[donkeypunch]

Foxtrot:

And the sad thing is, we as a profession have allowed the AANA to become this powerful. So we really have no one to blame but ourselves. So we, ourselves, have to start making some changes to distinguish ourselves as physicians.

You have been sleeping whilst the hospitals and CRNAs, assisted by the AANA have become powerful. Remember, while the hospital has other areas of it's budget eaten into by funding cuts, it looks for other ways to make up the revenue - IE hiring CRNAs. The same thing is happening to family practice. Take off your gloves.

 

[foxtrot]

Foxtrot:
You have been sleeping whilst the hospitals and CRNAs, assisted by the AANA have become powerful. Remember, while the hospital has other areas of it's budget eaten into by funding cuts, it looks for other ways to make up the revenue - IE hiring CRNAs. The same thing is happening to family practice. Take off your gloves.

Thanks for your input Mr. General Surgery Resident, it was very enlightening. 😎 Anyway, this is the thing I do not understand. Most of the CRNA's in the university setting make at least $120,000 a year and don't take call or work weekends. The ones who take call or work nights, make more than this. I don't know about you but that is much more than my salary as a resident and much more than anesthesia assitants. And in private practive CRNA's make even more and their malpractice premiums are not even comparable to an anesthesiologists. I know of 2 CRNA's in a rural midwestern town, where I did my rural general surgery elective as a medical student, who made more than the general surgeons. They openly would speak about it and joke about it. I know that it really irritated the surgeons I worked with. And it irritated me too. I would think that by hiring CRNA's that hospitals would lose money. It would seem more prudent to have more anesthesia residents and anesthesia assistants (at least in the university setting) than hire more CRNA's who don't even take call or work weekends and pay them over $100,000. Of course things are different in the private sector where you don't have anesthesia residents. And maybe the team oriented approach with a CRNA and an anesthesiologist is much more cohesive in private practice. But in the academic setting there seems to be a lot of negativity generated between CRNAs and anesthesiologists.... just my opinion.

 

[jwk]

Thanks for your input Mr. General Surgery Resident, it was very enlightening. 😎 Anyway, this is the thing I do not understand. Most of the CRNA's in the university setting make at least $120,000 a year and don't take call or work weekends. The ones who take call or work nights, make more than this. I don't know about you but that is much more than my salary as a resident and much more than anesthesia assitants. And in private practive CRNA's make even more and their malpractice premiums are not even comparable to an anesthesiologists. I know of 2 CRNA's in a rural midwestern town, where I did my rural general surgery elective as a medical student, who made more than the general surgeons. They openly would speak about it and joke about it. I know that it really irritated the surgeons I worked with. And it irritated me too. I would think that by hiring CRNA's that hospitals would lose money. It would seem more prudent to have more anesthesia residents and anesthesia assistants (at least in the university setting) than hire more CRNA's who don't even take call or work weekends and pay them over $100,000. Of course things are different in the private sector where you don't have anesthesia residents. And maybe the team oriented approach with a CRNA and an anesthesiologist is much more cohesive in private practice. But in the academic setting there seems to be a lot of negativity generated between CRNAs and anesthesiologists.... just my opinion.

Anesthesiologist Assistants (not Anesthesia Assistants) function identically to CRNA's in an anesthesia care team practice, whether employed by the hospital or a private anesthesia group. They are paid THE SAME as a CRNA in such a setting. AA's are NOT a cheaper type of anesthetist.

We also make more than anesthesia residents, or any other type of resident for that matter. Why shouldn't we? We've already completed our training and have entered practice. Once you complete your residency, the tables turn quickly.