SRNA

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anaesthetic said:
To contradict this, we work with CRNAs who train SRNAs (big metro level I trauma center), and a fair number of them stay on after graduating. Invariably, they still need about a year or so before they are actually up to speed on the acuity and pace of the practice (revise preop plans, PIV bailouts, intubation bailouts, intraop redirection, etc.). I can’t imagine leaving them alone in rooms as SRNAs.

We’ve hired recent CRNA grads from different, smaller, lower volume “training” programs, and most of us have had to work pretty hard to have them not kill patients outright. Some surgeons have complained about the new hires as well. Scary to think that SRNAs are being treated the same as residents at some places. The money must be good.
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Man those things sound kinda like....an anesthesiologists job.

If you don't do those things as an anesthesiologist then what the hell do you do?
 
I'm not trolling. Intraop redirection is literally going to be my job in a year. Same with being the expert on intubations and access. Also the same with pre-op plan adjustments. I mean that will literally be my job.
 
medicine2wallstreet said:
I'm not trolling. Intraop redirection is literally going to be my job in a year. Same with being the expert on intubations and access. Also the same with pre-op plan adjustments. I mean that will literally be my job.
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I feel sorry for you. You have a miserable life ahead of you. Life was must really suck at home if you have nothing better to do than be a troll online in your free time.
 
medicine2wallstreet said:
Our department has senior srna's in cases by themselves. I have never known of a glaring issue. Most srna's I know are very good. Obviously there are some clowns. But I know of a few clown attendings. And I am a CA3. Everyone should just relax in here.
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I'm going to give you the benefit of the doubt that you're not trolling here, and share a couple reasons why I think supporting this type of SRNA staffing model is harmful:

1) It reinforces the fallacy that SRNAs are interchangeable/equivalent to residents both to the RNs and to all of our perioperative colleagues.

2) Patients are never informed, in my experience, that they will be left alone with the SRNA for most of their case. They are allowed to assume an anesthesiologist or other qualified provider will be there with them immediately supervising. I think this goes beyond what's acceptable when the consent states "trainees may be present and directly involved in your care" when they are left in the room alone and may be forced to make split second decisions with heavy consequences in your absence.

3) Our professional society has taken a clear stance on the issue which we should support.

4) Most importantly, I truly believe even "senior" SRNAs have not achieved adequate training to safely handle the potential complications of routine anesthetics, let alone some of the trainwrecks in which I've seen them left solo. I've seen this model used in three different large hospitals which train SRNAs from 2 well-regarded schools... and there are glaring problems. I mean, if patients arresting in the operating room counts as glaring.

You're obviously free to make your own decisions when you go out there to practice. But keep in mind, advocating for this type of supervision speaks a lot to your own naivete and may wrap you up in unnecessary trouble.
 
I promise you I'm not naive. I'm just telling you what I've seen and experienced. I'm not advocating for them. Just stating what I've seen. That's it.
 
medicine2wallstreet said:
I promise you I'm not naive. I'm just telling you what I've seen and experienced. I'm not advocating for them. Just stating what I've seen. That's it.
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You’re a CA3? Let me point out- Residents see nothing. CRNAs see very little of each other. Supervising anesthesiologists have the best overview of people in the department.
 
It frustrates me so much that attendings use the word supervising so frequently and improperly. It's directing anesthesiologist. It's called medical direction. It's not a supervising anesthesiologist unless it's >4:1.
 
medicine2wallstreet said:
It frustrates me so much that attendings use the word supervising so frequently and improperly. It's directing anesthesiologist. It's called medical direction. It's not a supervising anesthesiologist unless it's >4:1.
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You don’t live in the real world that the rest of us do then.
 
medicine2wallstreet said:
I promise you I'm not naive. I'm just telling you what I've seen and experienced. I'm not advocating for them. Just stating what I've seen. That's it.
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Don't sell yourself short. You're naive AND you're advocating for them. SRNAs should NEVER be left alone in a room. They are students, not residents, despite what the AANA wants to call them. It's especially absurd that a department with anesthesia residents resorts to running rooms with SRNAs just to save a few dollars - because that's really the ONLY reason they're being left in rooms by themselves.
 
medicine2wallstreet said:
It frustrates me so much that attendings use the word supervising so frequently and improperly. It's directing anesthesiologist. It's called medical direction. It's not a supervising anesthesiologist unless it's >4:1.
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Thx for the clarification; we were all unsure about the terminology.
 
I promise you this. I'll never introduce myself as supervising anesthesiologist to a patient.

I am the anesthesiologist. No additive word needed.
 
medicine2wallstreet said:
I promise you this. I'll never introduce myself as supervising anesthesiologist to a patient.

I am the anesthesiologist. No additive word needed.
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Make sure you do what I do and pointedly refer to the CRNA as the "anesthesia nurse." Example: "Hi I'm Dr. BadAss. Susie, the anesthesia nurse, and I will be taking good care of you today. I'll be in charge of your anesthesia care and will ensure everything goes well."
 
Anesthesia_Guy said:
Make sure you do what I do and pointedly refer to the CRNA as the "anesthesia nurse." Example: "Hi I'm Dr. BadAss. Susie, the anesthesia nurse, and I will be taking good care of you today. I'll be in charge of your anesthesia care and will ensure everything goes well."
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I call them nurse anesthetist. It’s fine. Says nurse and is accurate.
The NP for nicu introduces herself as the Practitioner and leaves the nurse part out. It’s pathetic and intentionally misleading. Nothing wrong with being an NP, but there IS something wrong with hiding it.
 
sevo00 said:
lol "the practitioner." if i was a patient id think to myself wtf is the practitioner
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You’re not. And the public is too dumb or too scared to ask follow up questions.

One of these days I should just call myself anesthesia provider….. [emoji57]
 
triggermaster said:
I call them nurse anesthetist. It’s fine. Says nurse and is accurate.
The NP for nicu introduces herself as the Practitioner and leaves the nurse part out. It’s pathetic and intentionally misleading. Nothing wrong with being an NP, but there IS something wrong with hiding it.
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Im Dr. X, your anesthesia doctor, youll also meet Suzy the nurse anesthesist who works with me, like a physicians assistant. Thanks my line..
 
Srnas are not qualified to be left in the room alone. Period. Residents are medical doctors that just haven’t completed a specialty yet. Residents have a license to practice medicine.
Srnas are like pacu or icu nurses - they can’t be in the or alone either.
If I’m on that jury when something goes wrong leaving the srna in solo is patient abandonment and gross negligence.
 
amyl said:
Srnas are not qualified to be left in the room alone. Period. Residents are medical doctors that just haven’t completed a specialty yet. Residents have a license to practice medicine.
Srnas are like pacu or icu nurses - they can’t be in the or alone either.
If I’m on that jury when something goes wrong leaving the srna in solo is patient abandonment and gross negligence.
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This brings up an interesting question. Can CRNA program grads work as a CRNA before passing their CRNA exam? Board eligble anesthesiologists can work as anesthesiologists before becoming board certified.

According to the NBCRNA, 83% of first time test takers pass. What happens if they don’t pass? In general, are new grad CRNAs hired before or after they become certified?

NBCRNA Certification

The mission of the NBCRNA is to promote patient safety through credentialing programs that support lifelong learning. This page provides information about initial certification process.
www.nbcrna.com www.nbcrna.com
 
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nimbus said:
This brings up an interesting question. Can CRNA program grads work as a CRNA before passing their CRNA exam? Board eligble anesthesiologists can work as anesthesiologists before becoming board certified.

According to the NBCRNA, 83% of first time test takers pass. What happens if they don’t pass? In general, are new grad CRNAs hired before or after they become certified?

NBCRNA Certification

The mission of the NBCRNA is to promote patient safety through credentialing programs that support lifelong learning. This page provides information about initial certification process.
www.nbcrna.com www.nbcrna.com
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Yes. Depending on the state.

www.lawinsider.com

Graduate Registered Nurse Anesthetist (GRNA) Definition | Law Insider

Define Graduate Registered Nurse Anesthetist (GRNA). means an individual who has graduated from an accredited nurse anesthesia program, and is eligible to receive a limited Oregon license to practice within the CRNA scope of practice prior to attaining full certification, subject to the...
www.lawinsider.com www.lawinsider.com
 
Dr. Rude said:
Yes. Depending on the state.

www.lawinsider.com

Graduate Registered Nurse Anesthetist (GRNA) Definition | Law Insider

Define Graduate Registered Nurse Anesthetist (GRNA). means an individual who has graduated from an accredited nurse anesthesia program, and is eligible to receive a limited Oregon license to practice within the CRNA scope of practice prior to attaining full certification, subject to the...
www.lawinsider.com www.lawinsider.com
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Not sure it's everywhere but GRNAs used to be able to practice until 1) they passed their boards and became CRNAs or 2) they failed their boards in which case they had to stop practicing anesthesia until they can pass their boards on a subsequent attempt.
 
sorry my bar is a little higher than no "glaring issues." Thankfully it will never happen to me because I know better, but the unsuspecting public has no clue. What if that is your wife, husband, father, mother, child.... is an SRNA who may or may not be a clown but is certainly inexperienced be good enough for your loved one or yourself. if its not good enough for me, than it shouldn't be good enough for my patients. i wont apologize for giving a sh-- about my patients
 
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