Florida House reverses Ortiz decision, now senate vote pending

[toughlife]

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Some of you may remember the Ortiz decision in FL which stated the the CRNAs did not need supervision from MDA. The FL Board of Medicine fought back and on 3/25 the FLorida house voted in favor of the MDAs (99-13). Now the senate vote's is pending. Glad to see docs are fighting back.

Here's more info if you are curious:

HB 629/SB 1452 would restrict the practice of CRNAs...:
By deleting the statutory reference (section 458.331, F.S.) that was the basis of the Ortiz decision, HB 629/SB 1452 would effectively overrule the case and give the Board of Medicine the power to restrict the practice of nurses. 👍

http://www.fana.org/

 

[chicamedica]

I don't think it's just the MDA's fighting back. . .It's partly about doing what's in the best interest of the patient. Period. (imo anyway) Maybe the legislature is starting to be more understanding of this.

 

[Skip Intro]

Well, the most striking thing to me when you click the link (which is the Florida Association of Nurse Anesthetists) is this headline in big, bold letters across the top of the page...

Vote Sends Message That Nurses Don't Count In Florida

Not only is this unprofessional as well as just simply incorrect (nurses, namely "nurse anesthetists" which is what we are specifically talking about here, do count and are valuable team members) it is an example of the worst kind of political grandstanding and underscores the entire problem in this continuing debate.

By trying to further "emotionalize" this issue and extrapolate it into some silly notion that "nurses don't count" is deplorable conduct on the behalf of this organization. What "counts" most, as chicamedica said, is the patient's health and well-being. What few studies (and I emphasize the word "few") that are out there show that there are better outcomes when an MDA directs anesthesia care. We should not leap to a broad acceptance of non-MDA directed anesthesia care before we have more data, and that's the bottom line. To that end, we need to work together to better understand what's in the patient's best interest. I plan to be involved directly in such research when I get into my program, and I'm willing to let the chips fall where they may.

In the meantime, I know that FANA can't see past their own personal position on this issue (as well as their own vested interests), but I think they need to remember that they are still and will continue to be the highest paid sub-specialty of nursing. In the meantime, trying to eat their cake and still have it too has simply become annoying. I applaud the State Legislature in Florida for, at least in this instance, doing the right thing.

-Skip

 

[end_tidal]

Not to start a flame war or anything, but it is encouraging to see our community getting involved again because this is certainly an issue that needs to be addressed. Upon speaking with many CRNA's (esp. the young ones fresh out of school or in CRNA school), it's pretty clear that quite a few of them are ready and willing to encroach on our turf as far as we'll let them. I consider CRNA's our colleagues, but some of them are a bit too aggressive given their intended scope of practice. Thanks for the post. I'm interested in what some of the CRNA's or some of the senior guys here think (Tenesma, UTSW, JetProp, etc.).

 

[ThinkFast007]

Not to start a flame war or anything, but it is encouraging to see our community getting involved again because this is certainly an issue that needs to be addressed. Upon speaking with many CRNA's (esp. the young ones fresh out of school or in CRNA school), it's pretty clear that quite a few of them are ready and willing to encroach on our turf as far as we'll let them. I consider CRNA's our colleagues, but some of them are a bit too aggressive given their intended scope of practice. Thanks for the post. I'm interested in what some of the CRNA's or some of the senior guys here think (Tenesma, UTSW, JetProp, etc.).

i too applaud the FLA legislature! But, keeping in mind what End Tidal just said is of the highest importance. The younger and fresh CRNAs are certainly more 'proactive' and 'hungry' to use nice words. I've actually worked alongside many CRNAs (the older ones) who are very respectful of the MDAs and very congnizant of the boundaries. They make awesome teachers when it comes to intubating, doing spinals, etc....HOWEVER, the younger ones are certainly trying to do more. I've spoken with many who literally have told me (and i'm not blowing this out of proportion) that the only reason they take the heat and get beat on by the MDAs is so that they can later open up their own practices or learn the skills to be self sufficient. Most desire to be more self sufficient practioners in rural areas of the US and increase their salaries...

Once again just like ppl here have mentioned, CRNAs are the highest paid and probably the highest trained nurses and should be delighted. However, as with anything in life, when more is given MORE is desired......I've always wondered with all this talk on this forum about CRNAs getting their doctorates. So does this mean the very few anesthesists who introduced themselves as Nurse Joe or even Anesthesist Joe would now introduce themself as Doctor Joe?? If so what are the ramifications? What truly will distinguish a CRNA from a MDA to an AVERAGE (not rocket scientist) patient?

my 2 cents. Once again I think as young MDAs now and to be, it's incumbent upon us to straighten this out and do so in a way that is fair and just to all parties involved, rather than just playing nice guy or gal 😉

I think FL (atleast when it comes to this) has set a great precedent for other states to follow 👍

I'm certainly not degrading CRNAs here, their role is very important to us and to our future patients. However, I think certain checks and balances do need to be installed.

 

[HomerSimpson]

Well, the most striking thing to me when you click the link (which is the Florida Association of Nurse Anesthetists) is this headline in big, bold letters across the top of the page...



Not only is this unprofessional as well as just simply incorrect (nurses, namely "nurse anesthetists" which is what we are specifically talking about here, do count and are valuable team members) it is an example of the worst kind of political grandstanding and underscores the entire problem in this continuing debate.

By trying to further "emotionalize" this issue and extrapolate it into some silly notion that "nurses don't count" is deplorable conduct on the behalf of this organization. What "counts" most, as chicamedica said, is the patient's health and well-being. What few studies (and I emphasize the word "few") that are out there show that there are better outcomes when an MDA directs anesthesia care. We should not leap to a broad acceptance of non-MDA directed anesthesia care before we have more data, and that's the bottom line. To that end, we need to work together to better understand what's in the patient's best interest. I plan to be involved directly in such research when I get into my program, and I'm willing to let the chips fall where they may.

In the meantime, I know that FANA can't see past their own personal position on this issue (as well as their own vested interests), but I think they need to remember that they are still and will continue to be the highest paid sub-specialty of nursing. In the meantime, trying to eat their cake and still have it too has simply become annoying. I applaud the State Legislature in Florida for, at least in this instance, doing the right thing.

-Skip

The funny thing is you ask most real nurses (RN's) off the record what they think of CRNA's, you'll, 90% of the time, get a real negative reaction. Maybe they were just bs-ing me i don't know. Kind of suprising the first time i asked. In general RN's don't want to be lumped up with CRNA's. Just my observation. Try asking sometime.

 

[impetigo]

Upon speaking with many CRNA's (esp. the young ones fresh out of school or in CRNA school), it's pretty clear that quite a few of them are ready and willing to encroach on our turf as far as we'll let them. I consider CRNA's our colleagues, but some of them are a bit too aggressive given their intended scope of practice.

Of course they want to, why wouldn't they? I agree with your thought. People can speak as grandiosely as they want about "patient's health" and so forth, but if they are truly completely missing the politics in these issues, the fact that this really is a "turf war" that will be decided by politicians and lobbyists, then we really are going to be in trouble. At least, that's what I think!

😕

 

[chicamedica]

yeah i know it's a turf war. . .It shouldn't be. It should be about what's best for the patient. Sadly, it has been made into a turf war by those aggressive CRNAs mentioned. Let me just say not all CRNAs are like that. I have worked with some great CRNAs and I too value their contribution to the anesthesia/OR infrastructure.

But yes, the aggressive ones have forced MDAs into a turf war, which MDAs were slow to enter because i guess we just don't think that way. we're trained to put the patient first, usually. And doesn't common sense and ethics dictate this anyway?? It doesn't seem to me that it's something that has to be taught.

You know what though. . .i think it's just that MDAs are usually the nice, friendly people who don't tend to be hierarchical, so CRNAs have capitalized on this weakness. I now see that the strong, cold hierarchical culture present in surgery has it's reasons and does serve in putting the patient's safety first in a way. I myself don't thrive in such an envorinment but i'm starting to realize that there should be a limit on how "nice" one should be, if others are put in jeopardy.

 

[chicamedica]

The funny thing is you ask most real nurses (RN's) off the record what they think of CRNA's, you'll, 90% of the time, get a real negative reaction. Maybe they were just bs-ing me i don't know. Kind of suprising the first time i asked. In general RN's don't want to be lumped up with CRNA's. Just my observation. Try asking sometime.

Hmmm, i don't know. I think this animosity is for other reasons. CRNAs to me have seemed a lot more educated and motivated than the average RN. In fact, it's usually the best RNs that go on to become ICU nurses and perhaps enter CRNA programs. I haven't personally heard this reaction from RNs (never really brought up this subject with them), and excuse me if this sounds a bit crass, but i'd be inclined to think it's more about jealousy than anything else. my 2 cents.

 

[Skip Intro]

While some good points are made on this thread so far, no one kid yourself. This CRNA issue is about one thing, and one thing only: $$$.

-Skip

 

[ThinkFast007]

While some good points are made on this thread so far, no one kid yourself. This CRNA issue is about one thing, and one thing only: $$$.

-Skip

who was it that sung ..it's all about the benjamin's??

 

[DarksideAllstar]

who was it that sung ..it's all about the benjamin's??

P-diddy, byatch!

 

[ThinkFast007]

P-diddy, byatch!

lol...

Mo Money Mo Probs 😉

 

[toughlife]

great posts!
I agree with chica medica that most gas passers are chill and CRNAs are milking that to their advantage.

However, we must not be dumb enough to be taken advantage of. As was mentioned before, a clear structure must be defined and I favor always being the captain of the ship in terms of how much latitude a CRNA is allowed.
I know I sound like a broken record always harping about this issue, but I think apathy will get us all in trouble in the long run.

peace,

 

[ThinkFast007]

great posts!
I agree with chica medica that most gas passers are chill and CRNAs are milking that to their advantage.

However, we must not be dumb enough to be taken advantage of. As was mentioned before, a clear structure must be defined and I favor always being the captain of the ship in terms of how much latitude a CRNA is allowed.
I know I sound like a broken record always harping about this issue, but I think apathy will get us all in trouble in the long run.

peace,

all joking aside...I think this was a great Thread ToughLife...thanks for starting it...and I think this posted was started and maintained in a very professional way and luckily no flaming has transpired.

I want to just say one last thing. I agree with Chica..most MDAs are nice and I feel as a result they take a 'back seat'. Just as those 'young' CRNAs are being more aggressive, i feel us 'young' MDAs must step it up as well. It's time to stop being passive and alas show some assertiveness. I'm glad most of us here agree on this issue, I wish the ASA would address this in more detail (although I'm sure they're busy with their things, etc).

 

[zippy2u]

The crnas as a whole are very poor when it comes to regional blocks like interscalenes, femoral, sciatic, peribulbar blocks. The shame of it all is that with today's reimbursement the only way to make money is supervising your 4 rooms with crnas in each room. The doc gets "rusty" that way because you rarely get to do your own cases. In reality, the 5th person could actually be a CRNA in these surgery centers because the gravity of the cases is rather low. Florida hospital and surgery centers are very particular in that they want the deep pocket doc to be supervising over the CRNAs. Your job then becomes doing absolutely mindless preops on elderly cataract topical cases, endoscopy pts and podiatry. You also give them lunch breaks and other smoke breaks. You went to 12 years of schooling to do mindless preops and give breaks--- oh the incredible horrific boredom of it all. Regards

 

[joshmir]

good posts.

but instead of letting this be rhetoric, let's turn this into action- otherwise, you guys are part of the "MDA who do nothing and don't defend their turf"

call friends in FL and tell them to let their state senators know to support
SB 1452


this busy intern would like to see posts about *how to take action* as opposed to just why. if i wasn't on icu call i'd try to post some links. could some enterprising folk post a link for floridians to find email addresses and numbers of state senators in their district? instead, i will continue to say much, while doing little (except going back to sleep) 😴

 

[nitecap]

I am a SRNA at a CRNA program that coexist with a large MDA program that also has CT and OB fellowships and I can tell you that MDA's that I work with are hardly chill. I get pimped way more than residents. Even the residents try to pimp although I usually stump them. With all this political turf war evolving that predecesors in both our fields have left us with of course both srna's and residents are nervous but the 2 fields will continue to coexist. And you guys are correct, CRNA's are usually highly motivated, aggressive people.

So what is wrong with after I graduate to work in the Major teaching facility that I do and learn all that I can. Fine tune all my skills and become an expert at what I do. Then move to a small hickdick town say that has a 100bed hospital and small surgery center. Believe me these small towns may have 1 MDA practicing there, and would not be finacially worth it for you to be there. But for me contracting my services out I can make 190-200K instead on 130-140. I fill a need that this town has and make more $$ because this town cant afford more MDA's. So please tell me what the prob is with CRNA's movig to rural areas to provide services in an area that has need. Are any MDA's going to move out there and take a paycut. Prob not.

And yes CRNA's are more aggressive now than compared to the ones closing in on retirement. Listen, where I go to CRNA school it is not cheap. Just got my award letter $$ 10,800 a year just for tuition, including fees and books the program is 43K plus cost of living for 2.5yrs = 90k or more. I understand that this cost is not comparable to med school plus residency but it is still a large amt and I want there to be jobs (good paying) out there so i can pay this **** off. Of course its about the money, whether its MDA's or CRNA's. If its all about the pt why doesnt the MDA move to rural areas and work for 190 .

It is also about power though. Many CRNA's are very happy with their current salaries and not complaining at all. But when threatend MDA trys to limit a CRNA's practice when that CRNA has been practicing a certain way for 20plus years that is what causes the so called turfwar. When you tell Joe CRNA that he cant admin anesthesia for an outpt ENT case at a Surgey center when he's been feeding his family and putting kids through school doing this his whole career. Thats where the hard feelings and turfwars occur.

 

[zippy2u]

The PAC for the CRNAs is very strong and crnas almost universally are dues paying members and are making great political strides. Now the PAC for the MDAs in my opinion is not as strong and there is a disturbing number of docs who are not ASA members ( I being one and also not an AMA member). I find the whole MDA/CRNA/AA gig similar to racism in this country--(Concerning south Texas if you may) For years the white(MDA) man kept the Mexicans(CRNA) down and made them do menial tasks and "down in the pits" hard labor. Now comes along the black man(AA) and the mexicans are not doing the black man justice. The Mexican never learned. The Mexican forgets how horrible discrimination and injustice was from the white man because he(the Mexican) applies the same discriminatory feelings toward the black man. Aesop's little fable should be if the little mexican was smart he'd team up with black man and usurp control from the white man Regards, --zippy2u

 

[heartICU]

The crnas as a whole are very poor when it comes to regional blocks like interscalenes, femoral, sciatic, peribulbar blocks.

That all depends on where you work. Residents at my facility are often taught how to do regional anesthesia by CRNAs. Just remember that everyone has something to contribute. It's not always just physicians contributing for others benefit.

 

[24858]

crnas are making 190k and pissed about????
That is more than the average doctor, that is more than the avg anybody.
crnas need to seriously wake up and smell the coffee. If you all push mdas out of the field you better believe that I for one will seriously aggresively be politicking any and all senators, legislators, or whatever I can to get the salaries of you nurses cut big time. Health care is in a huge crisis and I see no justification whatsoever of paying any nurse 190k a year. That is just abuse of the system big time. You all are making way more than judges lawyers or any other professional never mind phds or other paraprofessionals. And please dont whine to me about your tuition and how you stump residents when they pimp you, b/c that crap dont fly with me. Plain and simple you are a nurse plain and simple. you deserve no more than 50k at most. In fact in I told the average tax payer that joe blow at the hospital, the local nurse at the hospital is pulling in 190K while you are working at the local mill and pulling in 20k I think the local taxpayer is going to be pissed off big time. In fact I'm pissed off bigtime as should be most other med students, doctors, lawyers, phds, judges, whoever rightfully did the educational time and has deserved to make some money, and most of the people who deserve to make big time money are being passed big time by the local nurse. I know a guy who graduated harvard law after going to brandeis and is making 90k working 90 hrs a wk in nyc, and some loser local nurse is complaining about 190k? Gimme a freakin break.. The problem is that the local loser nurse doesnt realize she is in for a freakin public relations nightmare once her salary is disclosed to the average working class stiff. But wait and see. Go ahead and keep biting the hand that has feed you and see the results. You all are going to go from the upper class as far as salary goes to more realistic 50k figures in very short time.

 

[Monty Python]

crnas are making 190k and pissed about????
That is more than the average doctor, that is more than the avg anybody.
crnas need to seriously wake up and smell the coffee. If you all push mdas out of the field you better believe that I for one will seriously aggresively be politicking any and all senators, legislators, or whatever I can to get the salaries of you nurses cut big time. Health care is in a huge crisis and I see no justification whatsoever of paying any nurse 190k a year. That is just abuse of the system big time. You all are making way more than judges lawyers or any other professional never mind phds or other paraprofessionals. And please dont whine to me about your tuition and how you stump residents when they pimp you, b/c that crap dont fly with me. Plain and simple you are a nurse plain and simple. you deserve no more than 50k at most. In fact in I told the average tax payer that joe blow at the hospital, the local nurse at the hospital is pulling in 190K while you are working at the local mill and pulling in 20k I think the local taxpayer is going to be pissed off big time. In fact I'm pissed off bigtime as should be most other med students, doctors, lawyers, phds, judges, whoever rightfully did the educational time and has deserved to make some money, and most of the people who deserve to make big time money are being passed big time by the local nurse. I know a guy who graduated harvard law after going to brandeis and is making 90k working 90 hrs a wk in nyc, and some loser local nurse is complaining about 190k? Gimme a freakin break.. The problem is that the local loser nurse doesnt realize she is in for a freakin public relations nightmare once her salary is disclosed to the average working class stiff. But wait and see. Go ahead and keep biting the hand that has feed you and see the results. You all are going to go from the upper class as far as salary goes to more realistic 50k figures in very short time.

Two main reasons CRNAs make that type of pay, especially in the boonies:

1. working 60+ hours/week, including the bring-back bleeding post-op CAGB at 0200 and other similar emergent, high-responsibility actions which are not found in the PhD, Attorney, Judge, Engineer, CPA, etc universe. Responsibilities such as those are rewarded with high compensation.

2. the basic foundation of free capitalism: the law of supply and demand.

 

[heartICU]

crnas are making 190k and pissed about????
That is more than the average doctor, that is more than the avg anybody.
crnas need to seriously wake up and smell the coffee. If you all push mdas out of the field you better believe that I for one will seriously aggresively be politicking any and all senators, legislators, or whatever I can to get the salaries of you nurses cut big time. Health care is in a huge crisis and I see no justification whatsoever of paying any nurse 190k a year. That is just abuse of the system big time. You all are making way more than judges lawyers or any other professional never mind phds or other paraprofessionals. And please dont whine to me about your tuition and how you stump residents when they pimp you, b/c that crap dont fly with me. Plain and simple you are a nurse plain and simple. you deserve no more than 50k at most. In fact in I told the average tax payer that joe blow at the hospital, the local nurse at the hospital is pulling in 190K while you are working at the local mill and pulling in 20k I think the local taxpayer is going to be pissed off big time. In fact I'm pissed off bigtime as should be most other med students, doctors, lawyers, phds, judges, whoever rightfully did the educational time and has deserved to make some money, and most of the people who deserve to make big time money are being passed big time by the local nurse. I know a guy who graduated harvard law after going to brandeis and is making 90k working 90 hrs a wk in nyc, and some loser local nurse is complaining about 190k? Gimme a freakin break.. The problem is that the local loser nurse doesnt realize she is in for a freakin public relations nightmare once her salary is disclosed to the average working class stiff. But wait and see. Go ahead and keep biting the hand that has feed you and see the results. You all are going to go from the upper class as far as salary goes to more realistic 50k figures in very short time.

First of all, CRNAs will not push MDs out of the field. There is a need for both professions, and probably always will be.

To address your other points, CRNAs DO "rightfully serve their education time." Becoming educated in the art and science of anesthesia isn't simply some correspondence course or a weekend inservice. CRNAs have bachelors' degrees AND masters degrees. [Before you argue, I am aware that some older CRNAs do not have this - they were educated before this became mandatory and grandfathered in]. But now, all CRNA programs are Masters programs, and will be doctoral programs in the future. Just because a CRNA does not have MD after his/her name does not mean s/he is not capable of providing quality anesthesia care.

You are right, health care IS in a huge crisis. There are not enough nurses and physicians to care for all the people who need care. Cutting salaries of ANYONE isn't going to help the problem.

I know that you are beginning your career in medicine, and I hope that you have a rewarding one, but I want to give you a piece of advice if I could: Nurses can be incredible assets to you. Treating a nurse badly not only speaks volumes about how you would treat patients, it also can make your life that much harder. Nurses, for the most part, truly will go out of their way to help you, especially in your residency, if you show them the respect they deserve. Just because they have a different background than you doesn't make them any less valuable to the healthcare team.

 

[UTSouthwestern]

I vote to shut this thread down now.