Question about CRNAs

[thomasc93]

Hi all,

I'm an undergraduate senior who was premed for a while, but I just decided that medicine was not the route I want to go, so I'm starting an accelerated BSN program in May with the intent of eventually within a few years becoming a CRNA, a PA, or an NP.

I'm particularly interested in becoming a CRNA because anesthesiology has always been of interest to me. As such, I've been reading through some general threads about CRNAs here on SDN. I do however have some questions about the CRNA scope of practice just because of some things I've been reading.

It was my understanding that CRNAs practice with some autonomy but are always practicing under an MD/DO anesthesiologist, sort of like a PA operates with autonomy under a licensed physician, with the physician being ultimately responsible. Is this true or do some CRNAs perform anesthesia totally independently? As a mid-level practitioner I would expect that they practice under a physician, but I'm finding some threads that seem to point to the contrary... Like I could see maybe independently/autonomously handling ASA Physical Status I and II cases with an anesthesiologist being on call in case something goes really horribly wrong, but handling ASA III+ cases without the supervision of an anesthesiologist or at least without one being on call is kind of risky, isn't it?

I mean from my perspective, they're all part of the anesthesia care team, so shouldn't they be working together to manage cases? Not one fighting the other for control? Or is this because of a shortage of anesthesiologists? I'm just so confused because I've heard so many things regarding what exactly is a CRNAs scope of practice.

Also, I guess just to check my own understanding, what is the exact role of a CRNA in the anesthesia care team? How will this role change in the future?

Thanks!

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[deleted162650]

All I'm gonna say is that if you think getting your BSN is somehow in the pathway to becoming a PA, then you have a lot more research to do before asking for specifics about CRNA scope of practice.

 

[thomasc93]

All I'm gonna say is that if you think getting your BSN is somehow in the pathway to becoming a PA, then you have a lot more research to do before asking for specifics about CRNA scope of practice.

Well I mean I say PA because many of the programs in my area require paid healthcare experience (like 2000 hours for some programs) and also as a route out of nursing in case I get sick of it...

 

[chocomorsel]

All I'm gonna say is that if you think getting your BSN is somehow in the pathway to becoming a PA, then you have a lot more research to do before asking for specifics about CRNA scope of practice.

There are RNs who become PAs and MDs. I am one. You can make it a pathway as long as you get the medicine pre requisites.

OP, there are CRNAs who work independently mostly in rural America but most work under an ACT model with physician back up. How much you do or what kind of patients you take care of depends on each individual practice.

 

[ranvier]

Hi all,

I'm an undergraduate senior who was premed for a while, but I just decided that medicine was not the route I want to go

When I left physical therapy for medicine, the internet forum world was not as robust so I spoke to clinicians, did some volunteering, found some trainees to speak with, etc. This really helped me decide. It can be hard to find answers but the real challenge is figuring out the questions you really care about.

 

[Tardis42]

There's certain procedures CRNAs can't do, mostly involving long heart surgeries. Also for CRNA school you need a year ICU full time working experience as a nurse for majority of the programs. Or a year in a lvl 1 trauma center. Some even require 2 years. I know all the ones around me require 2 years ICU and don't even accept ED experience. And right there that will get you close to the 2000 requirement for PA schools. You can't go right from a BSN program to CRNA program.

 

[Wiscoblue]

'Can't do' as in do not have the knowledge and critical thinking ability and training, or can't do because they are not being allowed to 'practice at the top of their license'?


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[Man o War]

CRNAs and cardiac cases are problematic in my experience for the following reasons:
1) I've never seen one who knows TEE
2) the surgeons don't generally want to work with them
3) a bunch of them are not proficient in central lines (if they've ever done one at all), and are spotty at best with other lines; if they have the ability they are usually slow which pisses off the surgeons
4) CRNA quality is very hit or miss, so consistency is lacking which matters when you have a very sick patient on the table; this goes for any big case, cardiac or not
5) hospital credentialing for cardiac
6) they may or may not have ever done a single cardiac case during their training, ive been told by others they can count simulations at some programs which we all know is BS if in fact is true.

Residents and fellows are always going to get priority for cardiac cases and TEEs since we have a minimum requirement, which keeps nurses from gaining proficiency on a large scale. I've heard them talk about establishing fellowships, but where are the cases/procedures going to come from?