More CRAP from the AANA....

[fakin' the funk]

This thread blows.

Agreed. Nurses, buzz off! See the "Anesthesiology" at the top of this forum? That's there because this forum is for physicians and medical students. I thought it was forum policy for the mods to kick off troublemaking nurses.

When I first started reading this forum about 10 months ago there were probably 5 threads a week dealing with real cases or practical issues in anesthesiology.

Now...this.

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[Gasboy07]

That's okay - they are most welcome to. As long as work the same hours, pay the same indemnity (and then some more for the lack of training), explain to the lawyers in court why they are practicing when inadequately trained... sure.

One of the big problems is that physicians as a whole are the only group who are trained to deal with the patient as a whole - as much as we take the piss out of the other specialties we have an understanding of what they can do and as well as how this patients other co-morbidities affect their overall management. In addition, the way the system has been set up (in Oz anyway) is that ultimately the doctor (no matter how junior) does all the thinking and carries the can if something goes wrong. He can always talk to the boss, but often the boss can only work on what the doc has said over the phone.

Nurses and other allied health professionals, scientists, ambos work by strict clinical practice guidelines / scopes of practice / whatever you call them... which is all well and good when there is somebody else to do the thinking... for the physician is well okay, lets see - the patient has this this and this, so this guideline / protocol / piece of evidence would be useful but with suitable adaptations.

If they want to expand their scope of practice then they better be able to do everything that goes along with that expanded scope... which means that if you want independent practice rights, you're on your own. and when you screw up, the hospital will hang you out to dry. I wonder how many of them would have thought about it this way?

 

[CremeSickle]

I agree

The sad part is it seems there isn't any room for opinion outside that of a select few. When they aren't 'followed' they quickly resort to personal insults and accusations. It makes us all look bad.

I went ahead and peeked back at all of those threads and noticed they were all started by physicians yet here many people are blaming nurses. As far as i can tell there are only 2. The RN fellow and trinity (both posted in this thread). Ive not seen either of them start a derogatory thread or BE disrespectful.

Just b/c i call it like I see it and have been an RN in the past doesn't make me a liar or deceiver. Maybe a closer look in the mirror would help a few of you have have confidence issues.

When I first started reading this forum about 10 months ago there were probably 5 threads a week dealing with real cases or practical issues in anesthesiology.

Now...this.

 

[johankriek]

I agree

The sad part is it seems there isn't any room for opinion outside that of a select few. When they aren't 'followed' they quickly resort to personal insults and accusations. It makes us all look bad.

I went ahead and peeked back at all of those threads and noticed they were all started by physicians yet here many people are blaming nurses. As far as i can tell there are only 2. The RN fellow and trinity (both posted in this thread). Ive not seen either of them start a derogatory thread or BE disrespectful.

Just b/c i call it like I see it and have been an RN in the past doesn't make me a liar or deceiver. Maybe a closer look in the mirror would help a few of you have have confidence issues.

whatever you say MUrse..

and i notice that trinity has vanished.. and I hope he stays vanished with his pro nurse (im independent), all doctors are idiots rhetoric. You all can go to your nursing forum to do that. Not on here

 

[VentdependenT]

You guys still want this trainwreck open?

 

[CremeSickle]

please close it VentdependenT.

 

[johankriek]

let the murses respond especially trinity who was so enthusiastic at the b eginning of this thread and after he is called out becomes very quiet. He had such ammunition bashing docs. Typical for someone who gets accepted to medical school and realizes he cannot handle the challenge

 

[dogbone65]

all doctors are idiots rhetoric.

You guys, I don't think anyone ever said that...it's a product of your paranoia and ego. There are idiots in any field, profession, etc....no one has a monopoly on it...just go for a drive....a lot of idiots have a driver's license. What is sad is the attitude. You have undertaken what most consider to be the most rigorous education and succeeded. That's great! You SHOULD be proud! It is an exceptional accomplishment. But that doesn't give you free reign to belittle and walk over others. The attitudes expressed here show some serious holes in your education. You not only violate some of the basic premises of a profession, but you especially degrade the acts of others who have gone before you. A profession, medicine especially, is here to serve. No one held a gun to your head and said you HAVE to go to med school. You did that of your own volition. No one has ever said being a doctor guarantees wealth. Nobody owes you a damn thing. You should feel privileged to have such trust placed on you. If you are so bitter because YOU made the decision to go to medical school, then don't take it out on others....you are accomplishing nothing, but demonstrating that you are an ass.

 

[BlackScorpion]

I don't understand why crnas/nurses come to this forum and make such asses of themselves. However, I do understand their frustration. The most bitter people I have encountered in medicine are middle aged male nurses who probably have visions of what could have been if they themselves took the time and made the sacrifice to go to med school. Now, unfortunately some of these murses have to go to anonymous forums to justify their occupations/existence. Sad.

 

[VolatileAgent]

.... No one held a gun to your head and said you HAVE to go to med school. You did that of your own volition. No one has ever said being a doctor guarantees wealth. Nobody owes you a damn thing.

you completely miss the point.

we did make the choice to go to medical school. we did choose to have superior training, and we don't believe - we know - this makes a difference in patient care.

what we won't stand for is those of you who do owe us that deference, yet continue to equate your training to ours, trying to take that away from us. your ilk is the one now holding the gun to our heads saying, in essence, that we have wasted our time and that your training is equivalent. literally, what you don't know can kill patients, but you haven't had enough training to understand that.

the "damn thing" you owe is respect, and understanding that it is you who made the choice not to go to medical school. on the whole, any given anesthesiologist any day of the week is a far better choice than any given crna.

so, don't come on this forum and preach to us. you have no real idea the sacrifices that a physician makes to get and, more importantly, stay where he/she is. fact is, you've probably never worked more than a 50 hour week in your life. most of us do this routinely, including many in private practice. until you're ready to buck-up and pull your weight, why don't you shut up?

 

[dogbone65]

you completely miss the point.

No...you do.

what we won't stand for is those of you who do owe us that deference, yet continue to equate your training to ours

I never have.

the "damn thing" you owe is respect

Respect is earned not owed.

so, don't come on this forum and preach to us.

I never have.

you have no real idea the sacrifices that a physician makes to get and, more importantly, stay where he/she is.

I do...it's just pathetic seeing you whine about a choice you made.

you've probably never worked more than a 50 hour week in your life.

I do all the time, I average 50-60; in fact when I was twelve (which was when the best part of you was running down your mother's leg) I was working about 80 hours a week shoveling manure out of horse stalls and hauling hay....I worked hours in the military that would make you cry like a little girl.

pull your weight

I do

why don't you shut up?

Because, just like you, I don't have to. Unlike you, I don't have to rely on the anonymity of the internet to give me balls.

 

[CremeSickle]

I have to agree with some of what VolatileAgent is saying here.

we did make the choice to go to medical school. we did choose to have superior training, and we don't believe - we know - this makes a difference in patient care.

Absolutely. Im a more effective, knowledgeable and well rounded provider now than i ever was as a nurse.

what we won't stand for is those of you who do owe us that deference, yet continue to equate your training to ours, trying to take that away from us.

When i was an RN i respected all people with an MD/DO b/c of their education. There is an expectation of people that comes along with the initials MD/DO. However, while i started with that respect it could decrease or increase based on actions (the earned part).

What your saying here i have seen on innumerable occasions with NPs and PAs (tho in my personal experience, not so much with CRNAs). NP/PA have (what i consider) a crappy education with a huge attitude.

The vast majority of CRNAs have much closer supervision than the average PA/NP. In 14 years working in hospitals I have never heard a CRNA disparage a physician. I have had many tell me they love working in ACT practices as they enjoy the backup of a qualified physician. I have 4 friends who went to CRNA school as I went to medical school. They have been practicing now for years and all of them are in ACT practices. They all love it and have never had a desire to change it. I think the general comments vs CRNAs here are just not a representation of the vast majority of them.

on the whole, any given anesthesiologist any day of the week is a far better choice than any given crna.

I just don't think it is that simple and it has yet to be proven. On big complicated cases with pts with co-morbidities, i absolutely agree we have the edge only a physician could. For the ASA 1&2 and maybe some 3s, not so much. In fact, as long as there is a supervising physician they get this backup.

 

[dogbone65]

Absolutely. Im a more effective, knowledgeable and well rounded provider now than i ever was as a nurse.

yup

When i was an RN i respected all people with an MD/DO b/c of their education. There is an expectation of people that comes along with the initials MD/DO. However, while i started with that respect it could decrease or increase based on actions (the earned part).

yup

NP/PA have (what i consider) a crappy education with a huge attitude.

yup

In 14 years working in hospitals I have never heard a CRNA disparage a physician. I have had many tell me they love working in ACT practices as they enjoy the backup of a qualified physician. I have 4 friends who went to CRNA school as I went to medical school. They have been practicing now for years and all of them are in ACT practices. They all love it and have never had a desire to change it. I think the general comments vs CRNAs here are just not a representation of the vast majority of them

yup

I just don't think it is that simple and it has yet to be proven. On big complicated cases with pts with co-morbidities, i absolutely agree we have the edge only a physician could. For the ASA 1&2 and maybe some 3s, not so much. In fact, as long as there is a supervising physician they get this backup.

[/QUOTE]

yup

 

[Disciple]

As an update:

In response to the lawsuit brought by physicians, the lower district court ruled against them, saying it was within the BON's authority to make the scope of practice ruling which supported the pain management CRNA's practice.

The apppeal court overturned the lower district court not on the merits of the case itself, but strictly because the BON inadvertently violated a procedural technicality in the state administrative code. The issue isn't dead.

The attorney for the CRNA in the case submitted a writ on 1/29/07 asking the court to overturn the decision and clairfy state law. I looked over the document posted on the ASIPP website

http://www.asipp.org/Jan.312007enewsupdate.htm#article3

It appears their argument is that by state law CRNAs are legally authorized to administer "all types of anesthestics in all settings", as if there isn't more to it than that.

 

[Stimulate]

The attorney for the CRNA in the case submitted a writ on 1/29/07 asking the court to overturn the decision and clairfy state law. I looked over the document posted on the ASIPP website

http://www.asipp.org/Jan.312007enewsupdate.htm#article3

It appears their argument is that by state law CRNAs are legally authorized to administer "all types of anesthestics in all settings", as if there isn't more to it than that.

Pain management is NOT the administration of an anesthetic and anyone who believes so shows only that they aren't educated enough to even know the difference. Truly sad. The Board of Nursing in LA needs to pull its head out of its ass. It is no surprise that the first state where this battle is being waged is also the state with the most corrupt litigation system in the US (second only to Mississippi).

If I were a plaintiff's attorney I would jump for joy when the first case arrives against a CRNA practicing pain management. In fact, although I am not in favor of medical malpractice lawsuits, I would definitely serve as an expert witness in any case against a CRNA practicing PM.

At a time when the ACGME is expanding the length of training for pain fellows from 12 to 18 months after residency, it makes no sense that a board of nursing can issue a ruling saying that CRNAs can practice PM. Most CRNAs do not even have a single rotation in Pain, so how can they possibly practice PM?

 

[johankriek]

I have 4 friends who went to CRNA school as I went to medical school. They have been practicing now for years and all of them are in ACT practices. They all love it and have never had a desire to change it. I think the general comments vs CRNAs here are just not a representation of the vast majority of them.
.

umm, i think it is based on the position of the AANA. WHich a majority of the CRNAs support.

Every anesthesiologist in training should be acutely aware of the political stance of the AANA. This is crucial. It is also crucial that all of us get involved with our state organization. Out here in california the CSA are a very strong organization. there are other states that support anesthesiologist as well. NJ being one of them off the top of my head.

I would like to hear the stance of the ASA about this. Of course we havent heard a thing. I guess its because they are one year term limits.

 

[dogbone65]

umm, i think it is based on the position of the AANA. WHich a majority of the CRNAs support.

Every anesthesiologist in training should be acutely aware of the political stance of the AANA. This is crucial. It is also crucial that all of us get involved with our state organization. Out here in california the CSA are a very strong organization. there are other states that support anesthesiologist as well. NJ being one of them off the top of my head.

I would like to hear the stance of the ASA about this. Of course we havent heard a thing. I guess its because they are one year term limits.

And the irony is, that many of the anesthesiologists that CRNA's know don't agree with all the pablum so many of you spew....politics..................

 

[toughlife]

Pain management is NOT the administration of an anesthetic and anyone who believes so shows only that they aren't educated enough to even know the difference. Truly sad. The Board of Nursing in LA needs to pull its head out of its ass. It is no surprise that the first state where this battle is being waged is also the state with the most corrupt litigation system in the US (second only to Mississippi).

If I were a plaintiff's attorney I would jump for joy when the first case arrives against a CRNA practicing pain management. In fact, although I am not in favor of medical malpractice lawsuits, I would definitely serve as an expert witness in any case against a CRNA practicing PM.

At a time when the ACGME is expanding the length of training for pain fellows from 12 to 18 months after residency, it makes no sense that a board of nursing can issue a ruling saying that CRNAs can practice PM. Most CRNAs do not even have a single rotation in Pain, so how can they possibly practice PM?

Why not send a notice to each state trial lawyers association notifying them of the new possibilities for malpractice litigation that will be available to them with midlevels practicing outside their scope of practice and their potential complications . I am sure they will be interested in learning where they can make some money

 

[jwk]

Why not send a notice to each state trial lawyers association notifying them of the new possibilities for malpractice litigation that will be available to them with midlevels practicing outside their scope of practice and their potential complications . I am sure they will be interested in learning where they can make some money

LOL - some of the "independent" CRNA's are now starting to grumble as they get their malpractice insurance renewals. Seems like some of them are getting socked with 50-100% premium increases. They're not happy. What a shame. They've been laughing for years that their premiums have been so low because they were "superior" providers. Let's see what they say when they start paying $30-40k a year in premiums or more.

 

[Disciple]

Why not send a notice to each state trial lawyers association notifying them of the new possibilities for malpractice litigation that will be available to them with midlevels practicing outside their scope of practice and their potential complications . I am sure they will be interested in learning where they can make some money

Great idea.

I can see the commercials now,

Do you suffer from chronic pain?

Have you had an injection to your neck performed by a nurse and suffered a stroke or even permanent paralysis?

Call The Wolf (310) 528-9482

 

[Gasboy07]

Hey it's only fair that the ambulance chasers share their love...

 

[johankriek]

Great idea.

I can see the commercials now,

Do you suffer from chronic pain?

Have you had an injection to your neck performed by a nurse and suffered a stroke or even permanent paralysis?

Call The Wolf (310) 528-9482

are you in west la disciple?

 

[Monty Python]

and i notice that trinity has vanished.. and I hope he stays vanished with his pro nurse (im independent), all doctors are idiots rhetoric.

As previously stated I have withdrawn from this topic .... except when factual errors are posted such as the above. I did not state "I'm independent" nor did I state "all doctors are idiots." Again, as stated repeatedly, why make such comments as a guest on this forum unless I'm trying to become banned (a totally illogical goal). Ungrounded extrapolations on your part are just that.

 

[VolatileAgent]

As previously stated I have withdrawn from this topic .... except when factual errors are posted such as the above. I did not state "I'm independent" nor did I state "all doctors are idiots." Again, as stated repeatedly, why make such comments as a guest on this forum unless I'm trying to become banned (a totally illogical goal). Ungrounded extrapolations on your part are just that.

yes, johann. i think you misdirected here. trin is one of the more respectable crna's who posts here. clearly, there's an agenda. but, respectable.

(i think it was you, trin, who not that long ago said that crna's could practice independently in 28 states. there are only 14 opt-out states. i meant to clear that up in my own mind. am i mis-remembering a statement you made? or, is that recollection correct?)