Acting smug about others doesn't always win you points among attendings though. Though I am genuinely amused by the reach-arounds going on here. With all the pairs constantly liking each other's posts.
Thanks Rendar5. No one said acting smug is going to get you anywhere--as a physician OR AS A RN. In fact, physicians may actually be a bit more tolerant of this than nurses, especially ICU RNs. They can be a tough bunch.
It's really sad that those attacking me so vehemently have not even looked at the particulars of what I am saying. They don't even realize that I agree that CRNAs should ALWAYS BE under anesthesiologist supervision. They realize I have advocated for direct presence of anesthesiologists on cases with families. My message was quite clear, and it was respected.
All this hubbub is extreme however. There are some radical CRNA types that want to function fully autonomously and there are many that do not. And if for no other reason, it's sad, but there is someone else to try and share the responsibility of outcomes. Why, b/c AS STRONG CLINICAL EXPERIENCE WILL DEFINITELY TEACH YOU (and has as of yet taught some of these students mouthing off about things they really don't know)----CRAP HAPPENS. It happens more than people know. If you work in a critical care area as a clinician you definitely will see and learn this.
People, however, shouldn't generalize and compare what they have seen, think they have seen or known with other nurse professionals. I stated this at the OUTSET of my responses in this thread. There is just too much variation and not enough standardization IMHO. You have to work with the individual RN directly--and in time--that's where you will see the qualitative differences in understanding pathophysiology, variations in responses to treatment, any number of things, that, however you want to slice it, yes, in fact are medical in nature. The overlap cannot be avoided, however, b/c there is not enough time for residents and fellows and attendings to stand over and monitor and evaluate critically ill patients progress continuously, 24/7. That is why they have these units. Unless docs can learn to become omnipresent or quickly clone and educate their clones, this is what needs to be in place.
I really think the some here do not understand a number of things. I was just reading the anesthesiologists thread on Joan Rivers. They will address some of the issues with putting sicker patients out on a non-unit floor and it has to do with the knowledge and experience and close monitoring abilities of the critical care RNs staffed in these units. Another wise anesthesiologist commented on the quintessential value of clinical experience. What isn't understood here is how closely critical care RNs work with residents, fellows, and attendings. Yes, this is in the field learning. Some nurses are better at going deeper into the medical science of what is going in with the patients and others may have only a baseline knowledge of critical problems and various nuance of changes physiologically speaking. But you must learn a certain amount of medicine for that patient to thrive or even survive. I mean it is what it is. But that does not mean I have stated that PGM programs are not superior in how they function, teach, and evaluate. Again, if you read one of my initial posts, you would see that I in fact stated that. More than once for God's sake. So the insane attacks are not based in anything but foolishness, lack of understanding, and IMHO arrogance that hopefully will be smacked out of some when they are in their PGE experiences.
For the anti-advanced practice arguments, I suggest delineating specifically on the lack of quality and quantity of hours AND the severe lack of standardized evaluation processes for them in contrast with the required standardized structure of PGME programs. The whole critical care and advanced practice nurses don't know squat argument will not work. There are those that know very little, and there are those that know a lot. And how things are applied by mere didactic understanding without understanding real life application of medicine, clinically speak--well it can be huge--even with or without evidence based practice. And you aren't gonna get this until you are working long hours in the midst of the action until residency and onward. If you have PA, NP, and strong critical care RN experience, residency will still be eye-opening and indeed have many robust experiences, but you may find that their is a stronger comfort and familiarity with approaches. Don't disregard and be hating on those people that have had the benefit of years of strong clinical experience. In due time, everyone more or less has to get onto the same page. Again, some of the now ignored commentators to my replies have misconstrued what I have state, and in general, just don't care to want to understand. I can't help that lines of close-minded thinking. I also hope they change their attitudes before residency, b/c they will need the support of strong critical care nurses caring for the patients for whom they will be given responsibility.
Last time: This SDN member never said CRNA is + anesthesiologists. I have worked extensively in these areas. I would NEVER SAY THAT based on experience alone. Why are people so quick to launch into attack rather than to try to understand? Could I be b/c they really don't want to do so? Now, that is truly a problem for them and for those with whom they work.