Every patient deserves an RN.. Oh the hypocrisy..

[IMGASMD]

I correct recruiters when they use that word to describe jobs

My SO did tell me to be nicer to the recruiters, because they may only have a high school education...... I thought about it....... and agreed.

I still have not understood fully when the recruiters tell me that I will be working along side of crna, but they’re independent. Anyone here can clarify what happens if the independent crna runs into trouble, do I intervene (yes)? What’s the implication? If they can have independent crna, why hire a physician?

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[deleted480308]

My SO did tell me to be nicer to the recruiters, because they may only have a high school education...... I thought about it....... and agreed.

I still have not understood fully when the recruiters tell me that I will be working along side of crna, but they’re independent. Anyone here can clarify what happens if the independent crna runs into trouble, do I intervene (yes)? What’s the implication? If they can have independent crna, why hire a physician?

“Do I sign their charts?”

 

[Southpaw]

My SO did tell me to be nicer to the recruiters, because they may only have a high school education...... I thought about it....... and agreed.

I still have not understood fully when the recruiters tell me that I will be working along side of crna, but they’re independent. Anyone here can clarify what happens if the independent crna runs into trouble, do I intervene (yes)? What’s the implication? If they can have independent crna, why hire a physician?

For the same reason some states have midlevel providers working independently and yet still have physicians. Because they need staff and still want physicians if they can afford/recruit them. I'd personally much rather do my work and have the CRNA do theirs, and if I had the option I'd rather be part of an all physician group. I don't want to be responsible for anyone's work but my own. If you're intervening to help, you're not 'signing the chart', you're providing help to a patient you're not responsible for and needs your assistance. No different than if you were called to the floor or ICU to help a crashing patient. Also, I'm not claiming anything will help you in a court of law if a case goes to trial, but neither will 'signing the chart' in a case that goes badly. I personally see intervening to help a crashing patient differently, but perhaps that's just me.

 

[pgg]

I used to moonlight at a place with "independent" CRNAs in their rooms doing their cases while I did my cases in my room. I found it a much better work environment than the places where I was supervising and directing.

Schedulers triaged them to less complicated cases and it worked out OK, mostly, except when it didn't. Side-by-side work with independent CRNAs seems awful on the face of it, both as a hazard to patients and a blow to the worth of physicians, but honestly I far prefer it to any arrangement where I'm responsible for their cases. If this is the bargain the public has made, having bought the AANA's lies about access and cost and safety, they're getting the healthcare system they deserve, and all I can really do is look out for myself and my family when we need care.

I'm happy to work with CRNAs in an ACT or similar practice where I know them and they know me, but I really hate working with them when I do locums. It's like a box of chocolates, except some of the chocolates have poison filling, and as the locums guy I don't know which ones those are until after I've taken a bite. Locums ACT work is the worst of all possible worlds.

 

[vector2]

I used to moonlight at a place with "independent" CRNAs in their rooms doing their cases while I did my cases in my room. I found it a much better work environment than the places where I was supervising and directing.

Schedulers triaged them to less complicated cases and it worked out OK, mostly, except when it didn't. Side-by-side work with independent CRNAs seems awful on the face of it, both as a hazard to patients and a blow to the worth of physicians, but honestly I far prefer it to any arrangement where I'm responsible for their cases. If this is the bargain the public has made, having bought the AANA's lies about access and cost and safety, they're getting the healthcare system they deserve, and all I can really do is look out for myself and my family when we need care.

I'm happy to work with CRNAs in an ACT or similar practice where I know them and they know me, but I really hate working with them when I do locums. It's like a box of chocolates, except some of the chocolates have poison filling, and as the locums guy I don't know which ones those are until after I've taken a bite. Locums ACT work is the worst of all possible worlds.

I think you had written about it before but I forgot....What is your liability like if you decide to be a moral person and assist one of the independent CRNAs if they ask for your help or if they're having an emergency or intraop code?

 

[deleted171991]

I think you had written about it before but I forgot....What is your liability like if you decide to be a moral person and assist one of the independent CRNAs if they ask for your help or if they're having an emergency or intraop code?

Captain of the ship (most educated provider). Anything that happens after one walks in the room can be blamed on one. I doubt that one can change a jury's mind that the doctor was just helping out the independent nurse.

 

[MirrorTodd]

I think you had written about it before but I forgot....What is your liability like if you decide to be a moral person and assist one of the independent CRNAs if they ask for your help or if they're having an emergency or intraop code?

Captain of the ship (most educated provider). Anything that happens after one walks in the room can be blamed on one. I doubt that one can change a jury's mind that the doctor was just helping out the independent nurse.

How are these cases treated in any other situation? I mean, a code blue gets called to an OR, a **** ton of people show up to help regardless of if it were a crna or physician. Does anyone know if everyone who shows up get named in a subsequent lawsuit or is it just the people who are on the chart?

 

[Neopolymath]

Captain of the ship (most educated provider). Anything that happens after one walks in the room can be blamed on one. I doubt that one can change a jury's mind that the doctor was just helping out the independent nurse.

I did not get further credentialing as a literal sailor for this reason. I didn't want to be in that situation on someone else's boat in the ocean.

 

[Urzuz]

Captain of the ship (most educated provider). Anything that happens after one walks in the room can be blamed on one. I doubt that one can change a jury's mind that the doctor was just helping out the independent nurse.

More than the jury, don’t think for a second that CRNAs will claim equivalence in this circumstance. They won’t hesitate saying that you are more qualified, have a higher level of education, etc and therefore should shoulder most/all the blame.

As heartless as it may be, this is the decision that CRNAs, surgeons, and public officials have made, so let them lie in the bed they have made. The key to not getting into this situation is to never offer to help and never set foot in that room.

 

[deleted171991]

How are these cases treated in any other situation? I mean, a code blue gets called to an OR, a **** ton of people show up to help regardless of if it were a crna or physician. Does anyone know if everyone who shows up get named in a subsequent lawsuit or is it just the people who are on the chart?

One may not be named initially, but what happens when somebody named blames one in a deposition?

The whole American judicial system is based on letting the small fish go, in exchange for a bigger fish to fry. In a bad malpractice state, I will only help a friend or partner, not just anybody. The more time passes, the less inclined I am to get involved in trouble.

I still have this image from internship in my mind: in case of code blue, the residents always ran towards the room, but the attendings were always running away.

 

[Man o War]

We must let them handle their own complications and issues. These “collaborative” models are terrible for this reason.
I think back to all the times I saw that deer in headlights look from a CRNA who was clearly in over their head when something horrible happened in a room and had no idea how to proceed...in that case you are going to be taking over, not assisting them.
Guarantee you will go down in court when the nurses, techs, everyone in that room tells the attorneys in deposition that you took over the case while the CRNA watched.

 

[pgg]

I think you had written about it before but I forgot....What is your liability like if you decide to be a moral person and assist one of the independent CRNAs if they ask for your help or if they're having an emergency or intraop code?

I've never had the misfortune to have to test it in court, and I hope I never do, but I think there's a strong argument that you're no more liable than for any other code blue you show up to. I mean, you have no prior involvement in the case, don't know anything about it, have no duty to the patient (1st of 4 elements of malpractice) so it'd be a massive miscarriage of justice to be held liable for whatever precipitated the crisis. I don't blame anyone who chooses not to respond for fear of the legal risk, but it's hard to not help when a patient is in need.

 

[IMGASMD]

I've never had the misfortune to have to test it in court, and I hope I never do, but I think there's a strong argument that you're no more liable than for any other code blue you show up to. I mean, you have no prior involvement in the case, don't know anything about it, have no duty to the patient (1st of 4 elements of malpractice) so it'd be a massive miscarriage of justice to be held liable for whatever precipitated the crisis. I don't blame anyone who chooses not to respond for fear of the legal risk, but it's hard to not help when a patient is in need.

I haven’t had the misfortune either.

Just as @FFP said, I thought the American way isn’t about who’s right or wrong anymore; it’s about who has the deeper pocket and last longer when they drag a case out to oblivion..... we all heard the stories about someone thought they didn’t do anything wrong, but the insurance still have them settled? Maybe just stories, at the same time, no one likes to admit any faults. ¯\_(ツ)_/¯

 

[nimbus]

Does anybody know of a case where a previously uninvolved anesthesiologist was named in a lawsuit because they got involved in a rescue situation? I have not.

 

[deleted697127]

Does anybody know of a case where a previously uninvolved anesthesiologist was named in a lawsuit because they got involved in a rescue situation? I have not.

I’ll try to look into this but i am skeptical you would be off the hook for litigation if you stepped in to rescue an airway after 3 attempts, and you yourself made an airway maneuver other than bagging. I suspect you would be named in a suit if there was a bad outcome.

How about this situation: BMI 35 but malampati 1. Malampati 1 falsely reassures everyone and a lazy effort is made for positioning. The eager med student going into anesthesia takes a look DL. Resident takes second look DL and also sees nothing. Bags and sats are 94. With VL attempt there is a little bleeding and there are some secretions. The airway is red and swollen at this point. Able to obtain 2b view but can’t maneuver the stylette in before sats start to drop from 94. Attending says bag them.

At this point there have been 3 attempts. Do these attempts all count? Some would argue maybe the med student isnt yet “a trained airway expert.”

So now what happens if the attending takes a look and can’t get it? Back up is called. And the back up attending takes a look with sats 91? LMA? Now what happens if this unfolded with an SRNA and CRNA and attending. There is a nonzero chance this will end poorly.

What do you do as the guy who happened to be available as backup? Why wouldn’t this happen with independent practice?

 

[deleted697127]

Does anybody know of a case where a previously uninvolved anesthesiologist was named in a lawsuit because they got involved in a rescue situation? I have not.

Physicians accept responsibility for Joan Rivers' death

Five physicians from New York-based Yorkville Endoscopy agreed to pay a

www.beckershospitalreview.com

“Five physicians from New York-based Yorkville Endoscopy agreed to pay a "substantial" amount and accepted responsibility for the death of comedian Joan Rivers to settle a malpractice lawsuit brought by her family, according to The New York Times.

In addition to the outpatient clinic, the lawsuit named ear, nose and throat physician Gwen Korovin, MD; anesthesiologist Renuka Bankulla, MD; two other anesthesiologists; and the former clinic director, Lawrence Cohen, MD, who has since stepped down from his post, according to the report.”

 

[Zekchar]

I'm happy to work with CRNAs in an ACT or similar practice where I know them and they know me, but I really hate working with them when I do locums. It's like a box of chocolates, except some of the chocolates have poison filling, and as the locums guy I don't know which ones those are until after I've taken a bite. Locums ACT work is the worst of all possible worlds.

100% agree. I tell recruiters who reach out to me and only allow myself to be presented for sites where its physician only practice. No chance I am willing to travel to some random place and work with random people I don't know and take on that responsibility.

 

[dannyboy1]

I've never had the misfortune to have to test it in court, and I hope I never do, but I think there's a strong argument that you're no more liable than for any other code blue you show up to. I mean, you have no prior involvement in the case, don't know anything about it, have no duty to the patient (1st of 4 elements of malpractice) so it'd be a massive miscarriage of justice to be held liable for whatever precipitated the crisis. I don't blame anyone who chooses not to respond for fear of the legal risk, but it's hard to not help when a patient is in need.

Code blue on the floor is frequently a very old sick patient who was expected to die = no lawsuit
Code blue in the OR is usually a young person with an airway issue = problem for anyone in the vicinity.

 

[anes121508]

This is my biggest takeaway from this experience. "Stable" employment is a fair weather friend. When times are good, you get normal pay, praise, hours, and "normal" experiences. The moment things get a bit tight, it's everyone for themselves. You will have your hours cut, your position furloughed, and your retirement plan contributions will be halted. Don't like it? Go pound sand.

I've read it before on this board and completely agree. Get your FU money and strive for financial independence ASAP. Do not do anything more than what is expected of you contractually or that doesn't help move your career forward in some way.

Call me a jackass, but clapping to support me and bringing me bagels for being a front-line worker is for suckers. I don't need trophies, badges of valor, or signs that call me a hero. I want my money, my hours, my retirement contributions, and for admins to step aside and let me do my job to the best of my ability. The hospital's finances is it's problem. I have 6 months of emergency funds and so should the system. Yes this experience has jaded me.

Pretty much agree with everything. People are out for themselves.... Jaded myself as well after seeing this situation play out.

The thing that I believe you didn’t mention though and I’m not sure where you stand on this...is that I believe it is possible to realize that people are all out for themselves and realize the game...but when push comes to shove I can’t swallow being that person.

Im fine doing things I believe in even when I know people are taking advantage of me.

I don’t give two Fs about bagels and signs. I don’t care about claps (it’s actually embarrassing and some part of me thinks people should be booing). I don’t care if people used my willingness to help to their advantage. I care about the damn patient and the families losing loved ones. Could be my folks. Could be my wife.in the end, that’s what matters. That’s what gets me down inside and that’s what made me want to work.

I’m not stupid, I realize people are taking advantage. Hell, people took advantage of me going to nyc and made my willingness to work an opportunity for bettering their bottom line. Does it make me sick? Yes. Jaded? Yes. But...am I going to sit home and not help? No. Am I going to ask for better pay? Maybe I should, but I’m not going to pull a LeVeon Bell.

 

[anes121508]

“You” was the generic pronoun for society in my statement. Some were making a pitch for volunteers. I was saying if that hospital is short handed, they need to pay

Hospital should be ashamed if they ask for volunteers and turn around and bill for the care.

People should be paid fairly. I’ve never argued otherwise. Fine if people volunteer. Hospital admin is gutless if they take handout from government, bill for services, and take volunteers. Right thing to do is thank person for volunteering but be the better person and pay them fairly.

 

[anes121508]

I am not talking of the ones who just “started” getting their hours cut. Plenty of people have been sitting around for weeks even months. When this thing was hot and heavy. Why didn’t they all flock up there to the hospitals that were paying?

I think it’s really a complex and multifacotrial issue.

It’s both provider and hospital and all the middle men inbetween...

 

[anes121508]

My price would have to cover 14 days of mandatory isolation when I return, so an additional 2+ weeks without pay. Add in missed family time and the discomfort of travel to a strange city with a legendary history of poorly staffed hospitals...
I don’t think any of those places would want to afford me.

our hospital is paying all the nurses and staff an extra 15/hr for caring for covid people, and some bonus for just being there. They offered 130/hr for CRNAs to be ICU nurses.
Physicians have been asked to volunteer. Later they offered to pay whatever the MGMA hourly rate is for your specialty.

There are still more physician volunteers than CRNA/nurses, because we are dumb.

I’m not dumb. I have my own motives and morals. In certain times those motives and morals trump all else.

But I get your point.

 

[anes121508]

I agree. We are dumb. We need to learn something from the nurses and their unions.
I have heard there are people negotiating a nice sum because of the quarantining after it.
Certainly no one should be “volunteering” for free. That’s bull.
However there are people negotiating over $500 an hour out there from what I am hearing.
I just want to know from the young resident what his fee is. To make it worth while.
Quite frankly, what’s to prevent one from going back to work immediately, after coming back there as long as you keep your N95 on at all times?
And it’s just not the city that is hurting. The suburbs and other cities in NY state are hurting as well. So their ratios may be better. I was not in the city than God and had about 10 patients daily.

I think I’m times like this when a hospital is being overrun and there is literally a flash flood taking over...every day wasted waiting for confirmation and negotiation adds to the problem. People sitting back and negotiating to get what they need to dive in and help only allows the problem to escalate and grow and get out of hand.

Needs to be a spit on hands and trust deal, emergency reserve providers, or set pandemic emergency rate. Not really time to F around.