The requirements to have a BSN and a year of critical care nursing (which is open to interpretation by each individual program) as a pre-requisite to enter a CRNA program are relatively new concepts that came about in the late 80's and early 90's.
Well, I at least gotta hand it to the AANA for trying to "step it up" as far as degree requirements and overall training. But, ulitmately, this is still only six years of formal education, I recognize.
AA's will also have six years of formal education - four-year bachelor's degree plus a two-year post-graduate degree specific to anesthesiology.
I like the fact that AA's recognize the limit of their training. I agree that a BSN plus one-year of CC training, then a two-year CRNA school does not necessarily a proficient clinician make. I have worked with some of these newly minted 25-year-old CRNAs, and it is scary what they don't know or understand.
Fact is, most of what we do is experiential. As anesthesiologists, in addition to a four-year post-graduate degree in medicine where we learn the intracacies of the human body and its disease states, we also have an additional four-years of formalized, supervised training by other physicians in our field. I believe we are taught to consider
many more variables concerning the whole patient's care. We are exposed to a far wider range of pathology and clinical scenario while still in a formalized, supervised milieu.
Most importantly, we are taught to make decisions and to stand by those decisions, good or bad. This is part of the "hidden curriculum" of medical school and residency. It does not exist in the nursing field. There is always someone to fall back upon when a nurse doesn't know what the best course of action is. There is always a "higher layer" of responsibility in their practice. Though they may contest that, it is a fact as part of their training. Patient management decisions are limited to their nursing role, not to the ultimate outcome and responsibility of that patient's global care.
What worries me most is the small contingent of militant CRNAs who don't think that extra training matters. The fact is that once you complete that formalized portion of your training, the rest is suddenly up to you. You either keep current and continue to learn, or you don't. The individualized portion of being a clinician becomes paramount. And, it is critical that you have the strongest foundation possible, in all realms, when you become an independent practitioner.
I'm certain that there are CRNAs out there, many of them, who would be capable of independent practice. I've met some of them. They adhere to best clinical practice and they strive to stay current, understand at a deeper level what they're doing, and genuinely are very intelligent people with their patient's best interest in mind.
Problem is, there are an equal many who aren't.
Now, some of the ones who aren't may recognize their limitations and
choose to continue to practice in the Anesthesia Care Team model. However, now that you've cracked the lid on the box, the ones who "don't know what they don't know" and can't appreciate their own limitations will want to crawl out. I don't know how you account for those while being far to the others, if you blanketly allow CRNAs to engage in fully unsupervised care, especially in the truly complex cases that we are additionally trained to handle.
Fact is, it's mostly only sick people that come to the hospital for care. And, we are living in a society that is going to soon be crushed by the wave of retiring baby boomers. Couple that with the fact that we also live in a society where obesity is an epidemic, and those patients have their own set of specific medical problems and concerns. I just don't know how you account for and monitor independent decision making in a cohort of practitioners that may not fully appreciate, despite their protestations to the contrary, all the things that could go wrong in that situation.
Proof is that two heads are better than one, and the two limited and flawed outcome studies that have been done to date at the very least agree upon that. If the AA model truly wishes to only operate in this paradigm, and will not 20 years from now find itself in the same situation as the AANA, then I say we do away completely with CRNAs. It's not worth the political hassle they are dredging up. They are distracting the public and politicians from us giving what is agreeably the best possible patient care model. They are gaming the legal system to meet a selfish end.
If this is the way it should continue, we, as a profession, need to focus our efforts on advancing the causes of the AAAA. We should not even entertain, advance, or empower - or perhaps even recognize - the efforts of the AANA, unless the legal system compels us. We should be working to get schools opened and legislation approved in all 50 states. We should be advertising, or helping them advertise, their profession. This could all be done in the most positive and creative of ways. The team concept is one that is golden among patients. They like to know that more people will be taking care of them, and that a doctor is always directly in charge of that aspect of their care.
What we need to do now is help build that infrastructure so that we can do this realistically. It will take years.
We should even invite nurses, freshly minted out of nursing school and who are interested in anesthesia as a career, directly into AA school without requiring the requisite 1-year of CC experience.
This is the way you win the cause.
-copro