Michigan scraps physician supervision requirement for CRNAs

[TheLoneWolf]

Michigan scraps physician supervision requirement for CRNAs - Becker’s ASC

Michigan Gov. Gretchen Whitmer signed a bill lifting restrictions on certified registered nurse anesthetists.

www.beckersasc.com

Michigan Gov. Gretchen Whitmer signed a bill lifting restrictions on certified registered nurse anesthetists.

House Bill 4359 removes the supervision requirements for CRNAs, according to the American Association of Nurse Anesthetists. Michigan is the 43rd state to lift the requirement, according to a July 13 news release.

CRNAs comprise 68 percent of Michigan's anesthesia care providers.

The AANA applauded Ms. Whitmer's action.

"Increased demand, limited resources, and the rural nature of the state dictate that a system capable of meeting the needs of all Michigan residents be maintained and this law provides that," AANA President Steven Sertich said.

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[GassYous]

Maybe now beaumont crnas will stop killing people

 

[anbuitachi]

43rd state??

 

[narcotics999]

Hopefully when Ms. Whitmer or her family needs surgery, a crna will provide the anesthesia.

 

[CopaceticOne]

"Increased demand, limited resources, and the rural nature of the state dictate that a system capable of meeting the needs of all Michigan residents be maintained and this law provides that," AANA President Steven Sertich said.

Sounds like a good reason to continue to push for modification of rural pass through legislation. Actually enable rural institutions to choose anesthesiologists to care for patients.

 

[coffeebythelake]

Hopefully when Ms. Whitmer or her family needs surgery, a crna will provide the anesthesia.

You know that won't happen. Ever. All this is done on the premise of increased access to anesthesia care for the poor people in the boonies. Lets send all these CRNAs there to practice what they preach. I'm waiting for them to move enmasse away from the city centers to "practice at the top of their license" and other such nursetalk nonsense.

Yeah that's not gonna happen. This is the gateway for them to open ketamine clinics, deliver anesthesia in plastic surgery offices, and some rather unsavory things. CRNAs gotta help those 50 year old mommies get their mommy makeover.

But the AANA would like you to think that "they are the answer"

Money and politics over quality care.

 

[nimbus]

You know that won't happen. Ever. All this is done on the premise of increased access to anesthesia care for the poor people in the boonies. Lets send all these CRNAs there to practice what they preach. Yeah that's not gonna happen. This is the gateway for them to open ketamine clinics, deliver anesthesia in plastic surgery offices, and some rather unsavory things. CRNAs gotta help those 50 year old mommies get their mommy makeover.

But the AANA would like you to think that "they are the answer"

Money and politics over quality care.

I’m just glad someone else is willing to give anesthesia for mommy makeovers.

 

[Blockit]

I’m just glad someone else is willing to give anesthesia for mommy makeovers.

I would love to, but I am too busy doing dead legs in Medicare scarecrows. 🤣

 

[coffeebythelake]

I would love to, but I am too busy doing dead legs in Medicare scarecrows. 🤣

To be clear that is unlikely the patient population these independent CRNAs are looking to take care of. Too much work and liability. And those Medicare dollars isn't going to cut it. They prefer young healthy, lots of leeway so they can cut corners and probably still turn out ok (and they can claim to do anesthesia so well). Just ask Rex Meeker.

 

[Status Sciaticus]

Maybe now beaumont crnas will stop killing people

I would think they would end up killing more since now there isnt any physician oversight required.

 

[deleted126335]

I would think they would end up killing more since now there isnt any physician oversight required.

Local hospital bylaws and employment contracts are the last line of defense.

 

[coffeebythelake]

Local hospital bylaws and employment contracts are the last line of defense.

are there any reputable hospitals you know of that have unsupervised crna ??

 

[Iso4ane]

I also like how the AANA called/implied that Michigan is a rural state that needs help (when it rounds out the top 10 of most populous states).

 

[deleted126335]

are there any reputable hospitals you know of that have unsupervised crna ??

Hospitals? NO.
Exceptions for free standing cataract center, plastic surgeon office. Don't know anything about the cataract place, but the plastic surgery place cherry picked well above average CRNAs that they got to know from working at the hospital. I would be OK with a healthy family member going there. Anesthesia for cataracts? Hard to make an honest case for MD involvement except for the sickest, super anxious, or weak ophthalmologist.

 

[DocVapor]

are there any reputable hospitals you know of that have unsupervised crna ??

Not yet, but soon:

Beaumont

 

[nimbus]

Hospitals? NO.
Exceptions for free standing cataract center, plastic surgeon office. Don't know anything about the cataract place, but the plastic surgery place cherry picked well above average CRNAs that they got to know from working at the hospital. I would be OK with a healthy family member going there. Anesthesia for cataracts? Hard to make an honest case for MD involvement except for the sickest, super anxious, or weak ophthalmologist.

There’s some interest in cataract surgery without anesthesia involvement. When I’m in an eye room I often ask myself WTF am I doing here. I feel like an elevator operator especially when I’m working with ophthalmologists who do cataracts in 7-10min. If it takes 45min, then I feel more useful.

IV-free sedation may help anxious cataract patients

Cataract surgery with or without intravenous sedation can be a factor in the clinical experience. Moving to sublingual sedation may be the next step in safety and comfort for a demanding patient demographic.

www.ophthalmologytimes.com

Cataract Surgery: Is an Anesthesiologist Necessary?

www.reviewofophthalmology.com

 

[coffeebythelake]

Not yet, but soon:

Beaumont

I said reputable.

 

[deleted126335]

There’s some interest in cataract surgery without anesthesia involvement. When I’m in an eye room I often ask myself WTF am I doing here. I feel like an elevator operator especially when I’m working with ophthalmologists who do cataracts in 7-10min. If it takes 45min, then I feel more useful.

IV-free sedation may help anxious cataract patients

Cataract surgery with or without intravenous sedation can be a factor in the clinical experience. Moving to sublingual sedation may be the next step in safety and comfort for a demanding patient demographic.

www.ophthalmologytimes.com

Cataract Surgery: Is an Anesthesiologist Necessary?

www.reviewofophthalmology.com

This can work.

Issue: need skilled optho doc. Both technically and patient communication skills. Also need optho doc to be wise in patient selection.

 

[Status Sciaticus]

Hospitals? NO.
Exceptions for free standing cataract center, plastic surgeon office. Don't know anything about the cataract place, but the plastic surgery place cherry picked well above average CRNAs that they got to know from working at the hospital. I would be OK with a healthy family member going there. Anesthesia for cataracts? Hard to make an honest case for MD involvement except for the sickest, super anxious, or weak ophthalmologist.

I mean, do most MD/DOs want to work in those settings?

Not yet, but soon:

Beaumont

Beaumont is trash.

There’s some interest in cataract surgery without anesthesia involvement. When I’m in an eye room I often ask myself WTF am I doing here. I feel like an elevator operator especially when I’m working with ophthalmologists who do cataracts in 7-10min. If it takes 45min, then I feel more useful.

IV-free sedation may help anxious cataract patients

Cataract surgery with or without intravenous sedation can be a factor in the clinical experience. Moving to sublingual sedation may be the next step in safety and comfort for a demanding patient demographic.

www.ophthalmologytimes.com

Cataract Surgery: Is an Anesthesiologist Necessary?

www.reviewofophthalmology.com

Well if youre not doing much, but still collecting the startup units and anesthesia time, can it be all that bad? Especially if its high volume like GI.

I said reputable.

Damn, you beat me to it.

 

[Agast]

This can work.

Issue: need skilled optho doc. Both technically and patient communication skills. Also need optho doc to be wise in patient selection.

My sister is an ophthalmologist in Michigan. A patient vagaled in PACU and her contribution was “Someone call the anesthesiologist!” I ribbed her for that one, but she’s really been so far removed from basic response care that she’s useless in a crisis. But she was 100% grateful there was a doctor there and not just the CRNA. I suspect most surgeons would feel the same.

 

[nimbus]

My sister is an ophthalmologist in Michigan. A patient vagaled in PACU and her contribution was “Someone call the anesthesiologist!” I ribbed her for that one, but she’s really been so far removed from basic response care that she’s useless in a crisis. But she was 100% grateful there was a doctor there and not just the CRNA. I suspect most surgeons would feel the same.

When our patients vagal, our nurses just lay them down flat and put a wet washcloth on their forehead. Not sure why but that’s the routine.

 

[deleted126335]

My sister is an ophthalmologist in Michigan. A patient vagaled in PACU and her contribution was “Someone call the anesthesiologist!” I ribbed her for that one, but she’s really been so far removed from basic response care that she’s useless in a crisis. But she was 100% grateful there was a doctor there and not just the CRNA. I suspect most surgeons would feel the same.

Vagal is not a verb.
If no competent person was there, would there likely have been a bad outcome?
ACLS certification does not equal competence.

 

[ProwlerturnGas]

Sure the hell is a verb. At least the way s/he used it!

 

[coffeebythelake]

When our patients vagal, our nurses just lay them down flat and put a wet washcloth on their forehead. Not sure why but that’s the routine.

hopefully they were feeling for a pulse too

 

[deleted126335]

Sure the hell is a verb. At least the way s/he used it!

Misuse.

Sincerely,

The grammar police.

 

[ProwlerturnGas]

Misuse.

Sincerely,

The grammar police.

Defund the police 😆

 

[chessknt]

Vagal is not a verb.
If no competent person was there, would there likely have been a bad outcome?
ACLS certification does not equal competence.

You should tell the gi docs that run their Endo center with no anesthesia backup. They are all acls certified so no worries if something happens.

 

[nimbus]

hopefully they were feeling for a pulse too

Not sure if they check a pulse but they get the wet washcloth every single time.

 

[GassYous]

When our patients vagal, our nurses just lay them down flat and put a wet washcloth on their forehead. Not sure why but that’s the routine.

That's what my mom used to do for me
Still does but she used to as well

 

[Aheadbyacentury]

What this legislation accomplishes is taking the insubordinate, hostile untrainable CRNAs that we work with now and make them even more so. Very soon it will be absolutely intolerable and not possible medically directing CRNAs after these legislations.. The answer is training the midlevels ourselves. Introduce AA/ PA legislation in every state and allowing PAs to become anesthetists..

 

[Zekchar]

What this legislation accomplishes is taking the insubordinate, hostile untrainable CRNAs that we work with now and make them even more so. Very soon it will be absolutely intolerable and not possible medically directing CRNAs after these legislations.. The answer is training the midlevels ourselves. Introduce AA/ PA legislation in every state and allowing PAs to become anesthetists..

Maybe. I don't totally disagree.

Also my inbox is flooded with needs for anesthesia locums. Rates higher than ever before. All kinds of accommodations all across the country. In the end, if you do not like your job you always have the right to quit and find a different one. Now is the best climate for that.

I agree that militant CRNAs are horrific and terrible to work with. I stand my ground with them when needed and now that little subset don't want to work with me. Life goes on and my feelings aren't hurt. The remaining CRNAs , who want to do as little as possible and have me as their medically directing backup, continue working as before. If you are having issues with some CRNAs that make your life difficult, refuse to work with them. Can't or won't be accommodated? Then quit and go elsewhere. But don't pretend that you are backed into a corner and have no options. That's disingenuous.

 

[Aheadbyacentury]

If you are having issues with some CRNAs that make your life difficult, refuse to work with them. Can't or won't be accommodated? Then quit and go elsewhere. But don't pretend that you are backed into a corner and have no options. That's disingenuous.

The problem with that is, then it becomes YOU complaining and YOU will be removed. I've seen it happen. BUt I agree it is an awful, awful situation. FUBARd. Again, medically directing CRNAs in this political climate does not have a future. EIther we train 5x more anesthesiologists and go back doing SOLO anesthesia or we train the AAs/PAs to become our anesthetists where we are in charge of their training.

 

[<(^_^)>]

The problem with that is, then it becomes YOU complaining and YOU will be removed. I've seen it happen. BUt I agree it is an awful, awful situation. FUBARd. Again, medically directing CRNAs in this political climate does not have a future. EIther we train 5x more anesthesiologists and go back doing SOLO anesthesia or we train the AAs/PAs to become our anesthetists where we are in charge of their training.

Right, but what they’re saying is if you DO get removed there are plenty of other jobs with less toxic environments and being removed from a toxic work environment is not a terrible thing in this job market. Obviously people have ties to specific areas etc. but it is true it’s not like there aren’t practices hiring all over the place.

 

[Aheadbyacentury]

Right, but what they’re saying is if you DO get removed there are plenty of other jobs with less toxic environments and being removed from a toxic work environment is not a terrible thing in this job market. Obviously people have ties to specific areas etc. but it is true it’s not like there aren’t practices hiring all over the place.

I get it, but its always more ideal (for your sanity) if you are not removed etc.

 

[<(^_^)>]

I get it, but its always more ideal (for your sanity) if you are not removed etc.

No argument there

 

[Robotic Wis-Hipple]

That's what my mom used to do for me
Still does but she used to as well

Is that you Mitch?

 

[D P356]

That's what my mom used to do for me
Still does but she used to as well

You’re not the only one. She does for me as well. Also, she says “hi.”
😉

 

[Gern Blansten]

Is that you Mitch?

My first thought as well. Miss that guy.