agree with you wholeheartedly; in my shop (Childrens Hospital) where I'm at most 2:1 and usually 1:1 , why do my colleagues let them put in A-lines and neuraxial (caudals, lumbar and thoracic epidural) and peripheral nerve blocks? I don't know! But it's more the norm and i'm an outsider and considered a poor team player for not letting them do anything. Those of us who put the patient safety first are relegated to MRI and other unappealing locations. The message is clear and loud at our shop. Aside from anesthetist satisfaction , what is the point of letting them do these procedures if you are right there. I have a hard time sitting back watching them flog a child...I think it's wrong to have someone more experienced sit back and not perform the procedure. Residents and fellows are a different situation, as they are training and they are the future. Even then, I have clear limits and step in, but what is the point with letting anesthetists do these procedures when you are right there? Please let me know how this is best for patient safety and our profession?
I can see a shop without a residency or fellowship program, running hard, 4 CRNA rooms most of the time, deciding to hell with it. Gonna make hay while one can. Spread themselves so thin that they need the CRNA's to step in and get that stuff done in order to keep work flow going. I almost signed on to a place like that as partner track and am glad I didn't. To some extent these are the sell outs.....
As for your situation, it's leadership and at this point probably just cultural. But, f.ck it. I would buck that trend and start asking my colleagues some tough questions. What you describe is indefensible in my mind and I think you are spot on in resisting that. Perhaps you can influence a change but be patient as these things take time.
Hell, in my mostly ACT model I still (and will always) take intubations on a regular basis (like if I have a 5 ETT case room, I'll take 1-2). We have a mostly good crew (mostly) of NA's, and I hear "it's good to see you guys intubate now and again, makes me feel safer for when I get into trouble". I am serious when I say that. Also, it sends a message to the NA, and the entire room that (in an ACT model this is only an issue), the doc still has his flow.....
Other ways in ACT models (perhaps more applicable in smaller or mid-sized facilities) is to go in for a break while waking a patient up and say "hey, I'll wake the patient up, you go take lunch". Arrange for appropriate coverage with your physician colleagues and you are good to go. I say small to mid-size because often you can "tweak" your coverage easier that way.
Now, that's very different from the cultural shift of taking away procedures, but I would just start saying, "I'll get the A-line on this one". Or, "you push meds, and I tube?" (Make it sound like a question but you're really not asking. Works well and they get the point)
Best of luck. Tough situation but it can be changed..... I have done it and it's not bee too hard. Our folks place a very very rare A-line, no blocks, hardly any neuraxial but we have a few CRNA's who do cover overnight epidurals (don't like it and we should stay in house) along with docs (it's a mix but NA and Doc not on same night).
