The ASA is asking for your help....

[kailiedu]

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Just to answer private messages regarding where this institution is located. It's in southern california, affiliated with one of academic centers in the area. The department chair of the academic center had enough with CRNA a few years ago, and fired all of his CRNA (from what I was told). Now his residents have to work pretty hard due to heavy case loads. However, they have solid training and are well-respected.

 

[jetproppilot]

I'm a resident in a program w/o CRNA. During my prelim year I did a 2wk rotation in anesthsia department. What I saw the relationship between CRNA (>30 of them) and anesthsiology MD (~5) was shocking. The CRNA would be sitting at one end of table and MD would be at the other end during the conference. As out-numbered as they are, they didn't have much "vocal" power either. In another case, I saw a senior CRNA actually told the director of anesthsiology and me, the rotator to get out of her room because the teaching was too loud.

jetproppilot, I enjoy your post on this forum. You give us valuable insights on anesthesiology, in knowledge and practice. However, I have to point out one of biggest problem I see in your posts regarding CRNA:

CRNA are NOT your friends. They are your workers.

In general, anesthesiologists are most laid-back MDs. CRNA are most vocal (mostly female, in their prime years). When you have two groups of exactly opposite people like this, you are bound to have problem, especially when you are out-numbered like the one I mentioned.

I'm telling you, it's bad there. So bad that it's a shame to be a MD anesthesiologist.

True, CRNA are your colleagues, they do intubation, they sit in the case. However, they are NOT MDs, they are NURSES. Just like scrub nurse, circulating nurses assist surgeons. W/o them, surgeons can't do a case. Surgeons never consider scrub nurses equal, nor do scrub nurses ever DARE to ask for equalities to surgeons.

Why?

Two reasons stand out in my mind: 1st, I have mentioned, personality. Anesthesiologists are not aggressive enough, especially with older generation FMGs. 2nd, most importantly, anesthesiologists use CRNA to take more calls, to run more cases. Gradually, they lose their authority and RESPECT among people working for them because they get TOO LAZY and GREEDY.

In a private practice, as jetproppilot often mentions, CRNA works with or for anesthesiologists. Sure, it's because they get paid more when MDs get paid more as a group. Profit is aligned. As a whole, CRNA organization is vocal to get rid of MD supervision.

It's a constant battle. It's not a battle to be lost.

I say end it all, by eliminating CRNA participation of organized group. When a CRNA is hired, first thing on the contract, is forbiding any participation of CRNA organization, period. If they want to have a job, they have to be an obedient worker. If they refuse, hire someone. If there are no CRNA willing to take on the job, hire AA, or start to train different groups of "technicians". After all, MDs have hiring power, not CRNA.

Be vocal, fight this battle. Anyone who doesn't see the risk of CRNA with growing power, please email me. I'd be happy to forward you the hospital I rotated and you should go and check it out.

NIce post Kail, and I respect your constructive criticism. Not sure I agree with it though. And nice counterpoint post, JWK.

For now, though, I'm gonna just sit back and enjoy the great posts on this thread.

Guess that 15-20 minute drive outta New Orleans on the Tuesday after the storm with my 2 year old in his babyseat behind me not knowing whether I was gonna be able to get us to the only entrance ramp to the only bridge outta the city has taken the wind outta my sails a little...makes this controversy seem silly, all things considered.

 

[Gimlet]

First of all, you as an AA is welcomed to make a comment here. I have no problem with it. So feel free to express your anger/frustration/or whatsoever towards your SUPERIOR. Yes, you heard it right, MD anethesiologists are your SUPERIORS, respect it, and accept it. Medicine is a field of hierarchy. If you are a nurse, no matter how good you are at placing IV, a-line, intubate, you are a nurse, period. If you feel you deserve more respect than a MD, please go through 4 yrs of college, 4 years of medical school, 4 years of residency before you can make a sound argument, REGARDLESS how much experience you have in NURSING.

I'll respect you as a NURSE because you have the skill we need, not because the years of academic education you have. Know your limit, respect your superior, or you won't find a job.

Kailiedu, posts like this are gonna get this thread shut down in a heartbeat. We've managed to keep this discussion relatively civilized so far, so let's please back off the nurse bashing so we can have a productive dialogue. If the thread gets locked we will lose UT's wise words in that great post to the depths of the SDN Forums!

 

[toughlife]

Kailiedu, posts like this are gonna get this thread shut down in a heartbeat. We've managed to keep this discussion relatively civilized so far, so let's please back off the nurse bashing so we can have a productive dialogue. If the thread gets locked we will lose UT's wise words in that great post to the depths of the SDN Forums!

Yeah or otherwise oldmandave may come and try to ban you from the forum 🙄

 

[kailiedu]

Thanks andy, for pointing out the possibility of my post leading to the shut-down of this entire threat. I've seen it happen. I used to wonder why MD/CRNA/AA argue about this all the time.

Trust me, i'd rather enjoy reading my Morgan then spending time writing all this. but, feel obligated to share what i've seen to the rest of my fellow residents. it's our future, our livelihood we're talking about, to say the least. On the top of that, we do have our pride to work this hard through undergrad, through MCAT, sacrifice much to go through medical school and years of residency.

I respect nurses. However, I do NOT consider them to be equal with MDs. (try to bring up this equality topic to general surgeons, they would not hesitate to yell scrub nurses out of their ORs)

The title of MD carries our professional pride, our value of education, our committment to patient care, our ability to take responsibility when the rest of health care profession stays aside.

If we are afraid of our voices being shut down, ignored, or argued against, we're losing our confidence, our pride, the very essence of being a physician.

So please, do NOT shut down this threat. Let them CRNA/AA look at us, proud generation of anesthesiologists.

I am sure, the respect will be, and has to been earned.

 

[toughlife]

Thanks andy, for pointing out the possibility of my post leading to the shut-down of this entire threat. I've seen it happen. I used to wonder why MD/CRNA/AA argue about this all the time.

Trust me, i'd rather enjoy reading my Morgan then spending time writing all this. but, feel obligated to share what i've seen to the rest of my fellow residents. it's our future, our livelihood we're talking about, to say the least. On the top of that, we do have our pride to work this hard through undergrad, through MCAT, sacrifice much to go through medical school and years of residency.

I respect nurses. However, I do NOT consider them to be equal with MDs. (try to bring up this equality topic to general surgeons, they would not hesitate to yell scrub nurses out of their ORs)

The title of MD carries our professional pride, our value of education, our committment to patient care, our ability to take responsibility when the rest of health care profession stays aside.

If we are afraid of our voices being shut down, ignored, or argued against, we're losing our confidence, our pride, the very essence of being a physician.

So please, do NOT shut down this threat. Let them CRNA/AA look at us, proud generation of anesthesiologists.

I am sure, the respect will be, and has to been earned.

Very well said!

While we are on this topic, I contacted the ASA to inquire as to why they were offering educational membership to CRNAs when its job is to be looking out for us not for them.
Here's their reply:

"Thank you for your e-mail, and concern regarding the specialty. ASA has
tried to take the high road regarding the struggles with the nurse
anesthetists, and now offers membership to both CRNA's and AA's for
educational benefits. The AA's and ASA agree on almost all issues
regarding the anesthesia care team, and this is reflective in the AA's
membership numbers and support of ASA. To date, only 7 of the 290
Educational and Educational Student members are CRNA's, and these
numbers are sure to be discussed at this years House of Delegates
Meeting.

If you are interested in getting involved in ASA's Resident/Medical
Student Committee, which is Chaired by Dr. Ronald Harter, you could
contact Dr. Harter at [email protected], or by calling
614-234-5190 (office)"

I encourage all of you to get involved. I sure will.

 

[jwk]

Trust me, i'd rather enjoy reading my Morgan then spending time writing all this. but, feel obligated to share what i've seen to the rest of my fellow residents

So please, do NOT shut down this threat. Let them CRNA/AA look at us, proud generation of anesthesiologists.

I am sure, the respect will be, and has to been earned.

Just a couple points and I'll quit fueling this particular fire.

1) Two weeks in a lousy practice as your only exposure to CRNA's isn't much to share or on which to base such strong opinions;

2) There's a difference between pride in your profession and being pompous;

3) Respect is definitely earned, not bestowed by degree. It goes both ways, not one.

 

[toughlife]

Just a couple points and I'll quit fueling this particular fire.

1) Two weeks in a lousy practice as your only exposure to CRNA's isn't much to share or on which to base such strong opinions;

2) There's a difference between pride in your profession and being pompous;

3) Respect is definitely earned, not bestowed by degree. It goes both ways, not one.

JWK, I believe he was referring to a teaching hospital he rotated at during his prelim year not a private practice.

 

[UTSouthwestern]

Kailiedu, posts like this are gonna get this thread shut down in a heartbeat. We've managed to keep this discussion relatively civilized so far, so let's please back off the nurse bashing so we can have a productive dialogue. If the thread gets locked we will lose UT's wise words in that great post to the depths of the SDN Forums!

Speaking of which, does anyone know what happens to old posts that go past your 500 post count? There are a few old posts I want to get at to clip and save for posterity.

 

[Gimlet]

Speaking of which, does anyone know what happens to old posts that go past your 500 post count? There are a few old posts I want to get at to clip and save for posterity.

OK, I feel like a stalker, but here ya go:

http://forums.studentdoctor.net/search.php?searchid=1262043

That should start back with your first post. I just did an advanced search on your name, and changed the "sort results" option from descending to ascending order. Hope that helps!

 

[UTSouthwestern]

OK, I feel like a stalker, but here ya go:

http://forums.studentdoctor.net/search.php?searchid=1262043

That should start back with your first post. I just did an advanced search on your name, and changed the "sort results" option from descending to ascending order. Hope that helps!

Figures it would be something as simple as "go to first post". Thanks, and why are you stalking me?????

 

[jetproppilot]

Figures it would be something as simple as "go to first post". Thanks, and why are you stalking me?????

Rock stars have stalkers. Its part of the gig.

 

[jwk]

JWK, I believe he was referring to a teaching hospital he rotated at during his prelim year not a private practice.

"During my prelim year I did a 2wk rotation in anesthsia department"


Regardless - by his own admision, he has two weeks of "experience" with CRNA's, and most of that I would assume was NOT actually working with the CRNA's. Pretty strong opinions for such limited contact, IMHO.

 

[kailiedu]

Look, my 2wks rotation in this anesthesia department is more than enough to show me the kind of disaster it could lead to if we let CRNA's aggressiveness continue. Actually, I did meet a few nicer CRNAs in the department. However, it's not the nice ones I'm concerned of. The older ones, who think they know what they are doing and don't need MD supervision are the ones who are rude and aggressive and dis-respectful to superiors.

Do u think if I stayed in the department I would see the magic change of aggressive behaviors among these CRNA? No. It won't negate what I have seen even in short period of two wks.

It should have never happen, not even for one day.

Imagine, a scrub nurse telling a general surgeon to get our of HIS/HER room, it would be the end of his career.

Now, for you, please be thoughtful before you post your msgs. There is a logic why I quote my 2wks of rotation. The fact you keep dwelling on this simply shows the lack of logic clear deductive reasoning process in your thinking.

College education, medical school education, residency training give you not only the medical knowledge, more importantly, enables you to think, to reason.

I'm afraid that's something you don't have.

"During my prelim year I did a 2wk rotation in anesthsia department"




Regardless - by his own admision, he has two weeks of "experience" with CRNA's, and most of that I would assume was NOT actually working with the CRNA's. Pretty strong opinions for such limited contact, IMHO.

 

[jetproppilot]

It reflects the disaster it could be heading to if anethesiologists aren't doing something about it.

Dude, I've been hearing this since residency (1992-1996). Even went to the state capital to lobby against whatever the then-current-disaster-waiting to happen was.

Now almost nine years in practice, I just dont see or feel the threat that the residents or newly-emerging anesthesiologists feel. Complacency? Maybe.

Or is it that the residents/newly-emerging anesthesiologists are reacting to "hype" created by the academic sector?

I've been where you are now. And felt like you do now. Nine years later, I'm still comfortable, my income is still, uh, more than I thought I'd ever make, I still like anesthesia, and our group is successful, fully staffed, with a stack of applications of people who want to work with us. This success didnt come by telling CRNAs "you're a subordinate, you're here because of me", blah blah blah.

If I would've bought into this "the-sky-is-falling" philosophy when I emerged from residency, the enjoyment of my specialty/life would've been blunted for the last NINE years.

I feel different now than I did when I was a resident...an evolution resultant from my experiences. This "The-CRNAS-Are-Gonna-Take-Over-The-World" topic is overplayed, in my opinion.

I've yet to work in a hospital that demands anesthesiologists in their hospital. And in the scenerios where there are no anesthesiologists (rural), I've yet to meet a CEO or surgeon who works there who wouldnt want an anesthesiologist if they could recruit one.

Bottom line? Pay attention to the ongoings. But dont obsess about it. If you do, you'll regret the time you lost when you look back over ten years of your career.

ANd consider that your current viewpoints, which are heavily influenced by academic physicians and a very inefficient, unorganized, poorly-informed-about-real-life anesthesia practices/relationships institution, may very well change when you are involved in a well oiled, safe, efficient private practice group that uses the team-approach model.

 

[etherRN]

jwk - very fair post. tough - you've got to be kidding, only 7 CRNAs.

k, ever watched killbill2? the part where bill says, "i've never been nice in my whole life, but i'll try my best ... to be sweet."

kelly, a concerned krankenschwester

 

[OldManDave]

Yeah or otherwise oldmandave may come and try to ban you from the forum 🙄

I am so laughing my @$$ off at this!

This thread, although contentious at times, is going pretty darned well for the most part. Important & heated issues are being hashed through in a surprisingly (for SDN) professional demeanor. There is no way I would shut down such a meaty/hefty thread...but, were individuals to descend to childish name calling or violate TOS, I would not hesitate to contact them individually. Afterall, like it or not - that is my job here.

 

[kailiedu]

I don't know how much independent practice right CRNA had 10 yrs ago, however, I do know 10yrs down the road, they have been granted to practice independently in a few states.

Do you call it a progress from CRNA's perspective? I think so.

Do you consider it a partial defeat of national ASA? I think so, too.

Why did this happen, a nurse telling MD to step-aside?

It's easy to forget about the conflict between anesthesiologists and CRNAs when you are in private practice, enjoying your private life and healthy paycheck. When everyone of us is only looking out for our own interest, easy-schedule, no calls, financial gain, no wonder CRNA can use its organizational power to "divide-and-conquer":

The falling of a few states to CRNA.

Please look beyond today, beyond what's in your private practice.

Even you consider CRNA your friends (trust me, I'd like to think the same, too). With the aggressive nature of CRNA organization, I would be very clear when interacting with these friends,

"know your limit, and respect your superior"

Only after their aggressive behavior are warned and checked, we can rest assured and be friends. After all, friendship means mutual respect.

An anesthesiologist has to realize, CRNA is the only nursing group who has gone so far to be granted most financial rewards and privilage in nursing field. It's also the only nursing group who dare to fight "turf-war" with MDs.

Think about it, this battle is ridiculous to begin with.

 

[coccygodynia]

Kaili - CRNAs practice independently in all 50 states.

 

[jetproppilot]

I don't know how much independent practice right CRNA had 10 yrs ago, however, I do know 10yrs down the road, they have been granted to practice independently in a few states.

Do you call it a progress from CRNA's perspective? I think so.

Do you consider it a partial defeat of national ASA? I think so, too.

Why did this happen, a nurse telling MD to step-aside?

It's easy to forget about the conflict between anesthesiologists and CRNAs when you are in private practice, enjoying your private life and healthy paycheck. When everyone of us is only looking out for our own interest, easy-schedule, no calls, financial gain, no wonder CRNA can use its organizational power to "divide-and-conquer":

The falling of a few states to CRNA.

Please look beyond today, beyond what's in your private practice.

Even you consider CRNA your friends (trust me, I'd like to think the same, too). With the aggressive nature of CRNA organization, I would be very clear when interacting with these friends,

"know your limit, and respect your superior"

Only after their aggressive behavior are warned and checked, we can rest assured and be friends. After all, friendship means mutual respect.

An anesthesiologist has to realize, CRNA is the only nursing group who has gone so far to be granted most financial rewards and privilage in nursing field. It's also the only nursing group who dare to fight "turf-war" with MDs.

Think about it, this battle is ridiculous to begin with.

I'm not disagreeing with your opinions on the aggressiveness of the AANA, and I do feel political groups working in our favor is necessary.
I do not feel, however, that one's political stance has to infiltrate the operating room. You are making the MD-CRNA "battle" personal, and you do not have to.

If you are a republican, do you scorn people that are democrat? I cant think of a bigger political battle than that one, and yet American people forge personal and working relationships independent of party loyalty.
Lets say I'm republican and I COMPLETELY disagree with many democratic standings. Lets say the democrats endorsed higher taxation for "high" wage earners. THat would be very threatening to me, right? So based on this hypothetical situation, should I select only republican friends/workers/spouse?

Its great that you are passionate about your cause. Avoiding bringing your opinions to the personal level will benefit you in the long run.

 

[toofache32]

So based on this hypothetical situation, should I select only republican friends/workers/spouse?

That's actually not such a bad idea. 😀

 

[kailiedu]

"Its great that you are passionate about your cause. Avoiding bringing your opinions to the personal level will benefit you in the long run."

Jetpropilot, thanks for pointing it out. I do appreciate this constructive advise: avoid direct confrontation with any particular CRNA at workplace.

And I do think CRNAs are skillful technicians who deserves our respect.

However, when they forget their place and act with aggression towards MD anesthesiologists (such as telling the director of anesthesia department to get out of her room), I will no doubt bring her to the example of aggressive CRNA being fired from her job in no time, regardless how many years of experience she has in CRNA.

It takes guts to do this against pressure. It has to been done, however.

An idea came to my mind, instead of let CRNA organization certifying CRNA, why doesn't ASA create a sub-organization that provide training, and certifying "CRNA"s? This solves certification problem, but also give ASA/anesthesiologists control of CRNA. Private/Public anesthesiology group will only hire these CRNAs, submitting to policy/restriction set by ASA.

Premature thought, what do you guys think?

 

[toughlife]

"Its great that you are passionate about your cause. Avoiding bringing your opinions to the personal level will benefit you in the long run."

Jetpropilot, thanks for pointing it out. I do appreciate this constructive advise: avoid direct confrontation with any particular CRNA at workplace.

And I do think CRNAs are skillful technicians who deserves our respect.

However, when they forget their place and act with aggression towards MD anesthesiologists (such as telling the director of anesthesia department to get out of her room), I will no doubt bring her to the example of aggressive CRNA being fired from her job in no time, regardless how many years of experience she has in CRNA.

It takes guts to do this against pressure. It has to been done, however.

An idea came to my mind, instead of let CRNA organization certifying CRNA, why doesn't ASA create a sub-organization that provide training, and certifying "CRNA"s? This solves certification problem, but also give ASA/anesthesiologists control of CRNA. Private/Public anesthesiology group will only hire these CRNAs, submitting to policy/restriction set by ASA.

Premature thought, what do you guys think?

I like it.

How about more AA's in the OR as well? I believe AA's are superb providers. Their training although shorter than MD training follows the medical model. I have worked with many of them and it was a joy.

 

[kailiedu]

enlighten me, how do AA and CRNA differ, in terms of education, organization, and most importantly, aggressive demand characteristics?

I like it.

How about more AA's in the OR as well? I believe AA's are superb providers. Their training although shorter than MD training follows the medical model. I have worked with many of them and it was a joy.

 

[toughlife]

enlighten me, how do AA and CRNA differ, in terms of education, organization, and most importantly, aggressive demand characteristics?

I think JWK is best qualified to do so. He is an AA and has been a long time contributor of this forum.

So JWK, if you are around, would you do the honors?

thanks,


P.S: I do know that the AANA is set against allowing AAs to increase their presence in the OR because they perceive them as competition against their CRNAs. As a result, I have not seen many AAs (PAs trained in anesthesiology) at my institution in the OR.
I have worked with them in surgery and medicine. They round with the medicine and surgery team and provide care for patients under the guidance of the attending or chief resident.

 

[jetproppilot]

This is an entirely different ballgame, deserving of a pink slip. Only in an academic behemoth would that be tolerated.

 

[rn29306]

It takes guts to do this against pressure. It has to been done, however.

An idea came to my mind, instead of let CRNA organization certifying CRNA, why doesn't ASA create a sub-organization that provide training, and certifying "CRNA"s? This solves certification problem, but also give ASA/anesthesiologists control of CRNA. Private/Public anesthesiology group will only hire these CRNAs, submitting to policy/restriction set by ASA.

Enough is enough.
No one "lets" the AANA certify CRNAs. Seeing how it was decided back in the 1930s that Nurse Anesthesia is separate from Anesthesiology (and I'm sure that most ASA card-carrying members wish he or she could change this), just how do you propose to topple the AANA and bring CRNAs under the umbrella of the ASA's wing?





That silence you hear is a big fat....."Ain't gonna happen".

Do me a favor and email the AANA about your plan, give your reasons for your opinion, and outline your strategy and post their reply here on this board.

Your ignorance of anesthesia is astounding considering your pompus vocal outpouring here. By your own admission, you spent two lousy weeks in a bad situation and now you are spearheading your own campaign here. Tell me, two weeks into an OB rotation, do you think you had enough of a grasp on the OB world to try and run the show? Did they make you chief res after your two weeks? Two weeks is enough to have an opinion, but an informed opinion is another topic altogether. Until you have more experience in anesthesia and see how different programs / groups run, your experiences don't reflect the majority and it would be nice if you would realize this.
Comparing scrub nurses and surgeons to CRNAs and anesthesiologists is utterly absurd and shows your shallow depth of understanding of anesthesia personnel and politics. You got told to leave a room......Get over it.

One of our anesthesiologists was scheduled to have his spine fused, who did he pick to deliver his anesthesia? One of his MD partners??? Nope. He personally requested the delivery of anesthesia by a CRNA in the practice. 'Nuff said.

You and toughlife knock yourselves out here.

 

[UTSouthwestern]

One of our anesthesiologists was scheduled to have his spine fused, who did he pick to deliver his anesthesia? One of his MD partners??? Nope. He personally requested the delivery of anesthesia by a CRNA in the practice. 'Nuff said.

and what is the name of this physician?

 

[rn29306]

One of our anesthesiologists was scheduled to have his spine fused, who did he pick to deliver his anesthesia? One of his MD partners??? Nope. He personally requested the delivery of anesthesia by a CRNA in the practice. 'Nuff said.

and what is the name of this physician?

Each of us has stories to tell. He told his. I have mine. You are entitled to question this story at will, but I am not stupid enough to release the name of one of my attendings over the internet, especially when it concerns a surgery of his. Sorry, but I cannot comply UTSW.

 

[toughlife]

Enough is enough.
No one "lets" the AANA certify CRNAs. Seeing how it was decided back in the 1930s that Nurse Anesthesia is separate from Anesthesiology (and I'm sure that most ASA card-carrying members wish he or she could change this), just how do you propose to topple the AANA and bring CRNAs under the umbrella of the ASA's wing?





That silence you hear is a big fat....."Ain't gonna happen".

Do me a favor and email the AANA about your plan, give your reasons for your opinion, and outline your strategy and post their reply here on this board.

Since when does the ASA need to ask the AANA for permission to do something?

Your ignorance of anesthesia is astounding considering your pompus vocal outpouring here. By your own admission, you spent two lousy weeks in a bad situation and now you are spearheading your own campaign here. Tell me, two weeks into an OB rotation, do you think you had enough of a grasp on the OB world to try and run the show? Did they make you chief res after your two weeks? Two weeks is enough to have an opinion, but an informed opinion is another topic altogether. Until you have more experience in anesthesia and see how different programs / groups run, your experiences don't reflect the majority and it would be nice if you would realize this.
Comparing scrub nurses and surgeons to CRNAs and anesthesiologists is utterly absurd and shows your shallow depth of understanding of anesthesia personnel and politics. You got told to leave a room......Get over it.

One of our anesthesiologists was scheduled to have his spine fused, who did he pick to deliver his anesthesia? One of his MD partners??? Nope. He personally requested the delivery of anesthesia by a CRNA in the practice. 'Nuff said.


You and toughlife knock yourselves out here.

Requiring an added certification by the ASA for CRNAs to be hired into a group does not sound difficult at all. All MD anesthesiologists have to do is decide they will hire only those who have this added certification. CRNAs that don't comply will not be hired. Just like you cannot be hired as a nurse if you don't have an RN certificate.

 

[jwk]

I like it.

How about more AA's in the OR as well? I believe AA's are superb providers. Their training although shorter than MD training follows the medical model. I have worked with many of them and it was a joy.

Whoa, tough - you've actually worked with AA's? I'll have to rethink my whole opinion now..... 😉


As far as the difference between AA's and CRNA's - let me respond tomorrow when I have more time to type.

 

[rn29306]

As a result, I have not seen many AAs (PAs trained in anesthesiology) at my institution in the OR. I have worked with them in surgery and medicine. They round with the medicine and surgery team and provide care for patients under the guidance of the attending or chief resident.

Just trying to clarify...Have you worked with AAs in the OR as delivering anesthesia or have you worked with medicine or surgical PAs either in the operating room on the surgeon's side of the BBB or rounding on patients?
From your post it seems like you are describing medicine or surgical PAs.
The education tracts for PAs and AAs are entirely different....

 

[toughlife]

Just trying to clarify...Have you worked with AAs in the OR as delivering anesthesia or have you worked with medicine or surgical PAs either in the operating room on the surgeon's side of the BBB or rounding on patients?
From your post it seems like you are describing medicine or surgical PAs.
The education tracts for PAs and AAs are entirely different....

Both. The AAs, I worked with were from Ohio (CCF/CWRU?) I think but I can't quite remember.

 

[jwk]

I think JWK is best qualified to do so. He is an AA and has been a long time contributor of this forum.

So JWK, if you are around, would you do the honors?

thanks,


P.S: I do know that the AANA is set against allowing AAs to increase their presence in the OR because they perceive them as competition against their CRNAs. As a result, I have not seen many AAs (PAs trained in anesthesiology) at my institution in the OR.
I have worked with them in surgery and medicine. They round with the medicine and surgery team and provide care for patients under the guidance of the attending or chief resident.

Here's a pretty good comparison of the two fields in general, although some of the numbers are out of date:

http://www.asahq.org/asarc/AA-CRNA_Comparison.pdf

The March, 2003 issue of the ASA Newsletter devoted it's cover topic to AA's.

http://www.asahq.org/Newsletters/2003/03_03/TOC_0303.html

AA's currently practice in 17 states and the District of Columbia. We are an approved anesthesia provider for Medicare (MD and CRNA are the other two), as well as TriCare, and the VA, so technically, an AA with a license in one state could work for the VA in any state, even one that doesn't license AA's.

In an anesthesia care team practice that utilizes both AA's and CRNA's, the job descriptions and compensation are identical. There are a handful of MD and AA-only practices, but the majority of practices that use AA's have CRNA's as well.

One correction and clarification needs to be made - AA's are NOT PA's trained in anesthesiology. Many refer to AA's as anesthesia PA's, but this is incorrect, although Georgia licenses their AA's as a specialty PA. AA's are a separate profession, with it's own set of certification and accreditation standards. In fact, PA's per se are not eligible for third-party reimbursement for actually administering anesthesia, since regulations specify MD, CRNA, or AA. You will occasionally find PA's working in pre-op and pain clinics, but it would be extremely rare to find one in the OR unless they have dual PA/AA certification.

I could bury you with info on this, so if anyone would like more info on AA's, please don't hesitate to PM me and I'll bury you in private.

 

[jwk]

Requiring an added certification by the ASA for CRNAs to be hired into a group does not sound difficult at all. All MD anesthesiologists have to do is decide they will hire only those who have this added certification. CRNAs that don't comply will not be hired. Just like you cannot be hired as a nurse if you don't have an RN certificate.

Medicine and nursing are two separate fields, each with their own licensure. Of course this by itself is one of the huge disagreements between anesthesiologists and CRNA's. Lots of interesting arguments come into play here, including restraint of trade (although the AANA really only sees one side of that issue).

Somehow I doubt that requirement could be added - there is a difference between licensure and a private corporation (which the ASA is) expressing it's preferences.

And to an earlier question/post about CRNA's being admitted as Education Members of the ASA - in order to obtain such a membership, the applicant (whether AA or CRNA) must complete an application, have it signed by two active members of the ASA, AND sign the application under a statement that the applicant agrees with the Guidelines for the Ethical Practice of Anesthesiology and subscribes to the Anesthesia Care Team Statement of the ASA. That would probably explain why there are only 7 CRNA Educational Members.

 

[jwk]

.

 

[nitecap]

let the force be with u

 

[jwk]

Nitecap, before I answer, let me ask the moderator if he'd like to put this into a separate thread, since these posts are getting kind of far removed from the original topic.

You pose some interesting questions which I'm more than happy to answer. I'll continue shortly...

 

[nitecap]

Nitecap, before I answer, let me ask the moderator if he'd like to put this into a separate thread, since these posts are getting kind of far removed from the original topic.

You pose some interesting questions which I'm more than happy to answer. I'll continue shortly...

Cool.

 

[OldManDave]

Nitecap, before I answer, let me ask the moderator if he'd like to put this into a separate thread, since these posts are getting kind of far removed from the original topic.

You pose some interesting questions which I'm more than happy to answer. I'll continue shortly...

JWK,

Not too bad an idea...a lot of great discussion occuring in this thread. But with the title being such as it is, I wonder how many folks are missing out. Of course, there is the risk that by starting anew w/ descriptive title will bring out the trolls & flamers too.

Your call...

 

[beezar]

At least I enter the OR having started IV's, pushed meds, managed vented pt's. The PA students dont even know what a stop cock is much less 12 stopcocks tied together with 10 drips infusing thru them.

Mastering the Anesthesia machine is an ongoing task for myself. I couldnt even imagine having to learn even the basic hospital equipment such as pumps and gas supplies and just things that even that average Nursing assistant knows from just being in the hospital.

Not at all discrediting the wealth of other experiences you gain as an ICU nurse, but starting IV's, pushing meds, learning about the anesthesia machine, gas supplies, pumps, stopcocks with multiple drips, and all the other technical aspects takes about at most 5 months to achieve a decent level of experience... all very intuitive.

Now sensing when a pt is heading one way or another takes way longer... and it all comes with time no matter what your degree...

 

[etherRN]

Oldmandave, good call. I think a new thread should be opened up with the topic at hand. I'll respond more when there is a focused topic.

 

[jwk]

JWK,

Not too bad an idea...a lot of great discussion occuring in this thread. But with the title being such as it is, I wonder how many folks are missing out. Of course, there is the risk that by starting anew w/ descriptive title will bring out the trolls & flamers too.

Your call...

New thread works for me - we definitely got sidetracked off the original ASA topic which was actually very important by itself.

 

[Tenesma]

I love when RNs state that they have experience in the ICU titrating drips, weaning vents, adjusting IABP, managed new heart transplants and taken care of VADs.... give me a break... who do you think gives the orders or writes the protocols for what you do? Do you think RNs initiate any of these medical decisions on their own?

I'd like to see the nurse who starts a patient on Vasopressin on their own.
I'd like to see the nurse who decides that CPAP is better than Pressure Controlled ventilation for a patient w/ bronchopleural fistulae on their own.
I'd like to see the nurse who places the IABP and then decides when to turn it off.
I'd like to see the nurse troubleshoot the VAD and manage a patient who has loss of the pneumatic drive and has a BP of 50/40 and is in CHF - on their own.

Let me help paraphrase your initial statement. Nurses see a lot of things at the bedside, and over time their knowledge base grows based on previous experiences/exposures but minimal understanding of the underlying issues. They see a patient on dopamine for BP support then think that dopamine is the best way to maintain BP... They see Zosyn and start believing that is the best way to treat pseudomonal infections... medicine is more than protocols and algorithms... medicine is more than turning levophed from 8mcg/min to 6mcg/min because a patients vascular tone is recovering from SIRS.

gimme a break... my wife was an ICU nurse for 12 years (until last year) and was very good at what she did, but she still came to me (even when i was a med student) to have me explain why and what and where...

go to med school if you want to practice medicine
go to CRNA school if you want to practice advanced nursing

 

[Orchard]

👍

Excellent post that I and my colleagues wholeheartedly agree with.

 

[lvspro]

I love when RNs state that they have experience in the ICU titrating drips, weaning vents, adjusting IABP, managed new heart transplants and taken care of VADs.... give me a break... who do you think gives the orders or writes the protocols for what you do? Do you think RNs initiate any of these medical decisions on their own?

I'd like to see the nurse who starts a patient on Vasopressin on their own.
I'd like to see the nurse who decides that CPAP is better than Pressure Controlled ventilation for a patient w/ bronchopleural fistulae on their own.
I'd like to see the nurse who places the IABP and then decides when to turn it off.
I'd like to see the nurse troubleshoot the VAD and manage a patient who has loss of the pneumatic drive and has a BP of 50/40 and is in CHF - on their own.

Let me help paraphrase your initial statement. Nurses see a lot of things at the bedside, and over time their knowledge base grows based on previous experiences/exposures but minimal understanding of the underlying issues. They see a patient on dopamine for BP support then think that dopamine is the best way to maintain BP... They see Zosyn and start believing that is the best way to treat pseudomonal infections... medicine is more than protocols and algorithms... medicine is more than turning levophed from 8mcg/min to 6mcg/min because a patients vascular tone is recovering from SIRS.

gimme a break... my wife was an ICU nurse for 12 years (until last year) and was very good at what she did, but she still came to me (even when i was a med student) to have me explain why and what and where...

go to med school if you want to practice medicine
go to CRNA school if you want to practice advanced nursing

Nice

 

[rn29306]

I love when RNs state that they have experience in the ICU titrating drips, weaning vents, adjusting IABP, managed new heart transplants and taken care of VADs.... give me a break... who do you think gives the orders or writes the protocols for what you do? Do you think RNs initiate any of these medical decisions on their own?

I'd like to see the nurse who starts a patient on Vasopressin on their own.
I'd like to see the nurse who decides that CPAP is better than Pressure Controlled ventilation for a patient w/ bronchopleural fistulae on their own.
I'd like to see the nurse who places the IABP and then decides when to turn it off.
I'd like to see the nurse troubleshoot the VAD and manage a patient who has loss of the pneumatic drive and has a BP of 50/40 and is in CHF - on their own.

Let me help paraphrase your initial statement. Nurses see a lot of things at the bedside, and over time their knowledge base grows based on previous experiences/exposures but minimal understanding of the underlying issues. They see a patient on dopamine for BP support then think that dopamine is the best way to maintain BP... They see Zosyn and start believing that is the best way to treat pseudomonal infections... medicine is more than protocols and algorithms... medicine is more than turning levophed from 8mcg/min to 6mcg/min because a patients vascular tone is recovering from SIRS.

gimme a break... my wife was an ICU nurse for 12 years (until last year) and was very good at what she did, but she still came to me (even when i was a med student) to have me explain why and what and where...

go to med school if you want to practice medicine
go to CRNA school if you want to practice advanced nursing

The poster was comparing a seasoned ICU nurse to what he or she perceived as never-been-in-a-hospital-setting AA student when both end up in anesthesia school. No reference was made to medical students, MDs, or anything else. You missed the point in an attempt to quickly criticize nursing once again. Same goes for all that agreed with you.

 

[ear-ache]

I tried to PM you, but your mailbox is full. Thanks.

 

[nitecap]

I love when RNs state that they have experience in the ICU titrating drips, weaning vents, adjusting IABP, managed new heart transplants and taken care of VADs.... give me a break... who do you think gives the orders or writes the protocols for what you do? Do you think RNs initiate any of these medical decisions on their own?

I'd like to see the nurse who starts a patient on Vasopressin on their own.
I'd like to see the nurse who decides that CPAP is better than Pressure Controlled ventilation for a patient w/ bronchopleural fistulae on their own.
I'd like to see the nurse who places the IABP and then decides when to turn it off.
I'd like to see the nurse troubleshoot the VAD and manage a patient who has loss of the pneumatic drive and has a BP of 50/40 and is in CHF - on their own.

Let me help paraphrase your initial statement. Nurses see a lot of things at the bedside, and over time their knowledge base grows based on previous experiences/exposures but minimal understanding of the underlying issues. They see a patient on dopamine for BP support then think that dopamine is the best way to maintain BP... They see Zosyn and start believing that is the best way to treat pseudomonal infections... medicine is more than protocols and algorithms... medicine is more than turning levophed from 8mcg/min to 6mcg/min because a patients vascular tone is recovering from SIRS.

gimme a break... my wife was an ICU nurse for 12 years (until last year) and was very good at what she did, but she still came to me (even when i was a med student) to have me explain why and what and where...

go to med school if you want to practice medicine
go to CRNA school if you want to practice advanced nursing

I can adjust VADS and IABP just as good if not better than any 1st or 2nd year anesthesia, IM resident. Though I def. can not insert one and have no desire to do so I can make balloon adjustments as well as VAD adjustments very well. Many Anesthesiologists run the case and may make VAD and Balloon adjustments in the OR but when the pt comes out and is in the ICU wks to months unless the Anesthesiologist is a critical care intensivist working in the ICU they make little if any device mgmt decisions. Come on now how often do you really make VAD changes, dont inflate yourself. At any facility that I have worked at though the Anesthesia MD may make VAD changes in the OR we all know it's either the surgery of TP cardio or VAd program coordinators that adjust the VAD most of the time

I have become quit an expert on the Debakey Medtech axial flow vad and will put my knowledge and experience to any resident. Im pretty competent managing hearmate I, thoratec, biomedicus and abiomed as well. I have studied probrably the same literature you have. I have managed many many VAD pt's, though not in OR. MOst of the time they crump post-op anyways and reg anesthesia is no where near unless they are bringing the pt back and still it is doubtful that anesthesia is going to be making any drastic VAD setting changes. Intra-op you have way more experience than I, but post op i can trouble shoot VAD related issues as well as many anesthesia residents. Anesthesia has little hands on with vads if any intra op in my experience, and when so they always collaborate with surgery or perfussion before pressing buttons, increasing flows or RPMS, switching drives or even manually pumping and changing filters if needed in emergencies.

Im my experience most anesthesia residents have no clue when It comes to the VAD. They may have a general understanding of how it works but they have no clue how to trouble shoot alarms, DisConnect pt and manually pump if needed, assess bladder filling to assess volume status, do flash tests to assess filling ect. Most of the time when receiving a pt from OR the balloon timing is totally off and needs adjustments anyway.

Again I understand that different facilities may have different services handling these issues so you may been the VAD GOD who knows. But most VAD pt's crump post-op and RN's manage VADS very well. Most VAD coordinators at facilities are RN's as well. I would rather the VAD coordinator RN make Vad changes sometimes rather than any MD. When your at the bedside 12hrs a day 4 x a week with a VAD or balloon pt you get to know that pt and his device very well and are able to recognize subtle changes either in the pt or device itself. Its all about experience man, either you have it, you want it or you are trying to get it. Your medical knowledge makes no difference when you are managing a pt and you are not an expert on the device. Quit inflating your education and expertise.

What type of VAD are we talking about in your hypotensive pt with a vad malfxn. What else is going on? Please understand that you do not know it all. Sometimes there is and will be someone out their with not as extensive an education as you that may be smarter than you and more competent than you at certain aspects of certain issues. Its ok to acknowledge that you dont know at all. Dont be to proud to learn a few things from this person like many of you are. Correct me if I am wrong but :

MD does not stand for = I know everything about every medical issue know to man and I am correct all the time, and am to proud to admit I need to learn and study something more in dept. Just curious thought it stood for Medical Doctor or something, maybe Im wrong.

 

[jetproppilot]

I can adjust VADS and IABP just as good if not better than any 1st or 2nd year anesthesia, IM resident. Though I def. can not insert one and have no desire to do so I can make balloon adjustments as well as VAD adjustments very well. Many Anesthesiologists run the case and may make VAD and Balloon adjustments in the OR but when the pt comes out and is in the ICU wks to months unless the Anesthesiologist is a critical care intensivist working in the ICU they make little if any device mgmt decisions. Come on now how often do you really make VAD changes, dont inflate yourself. At any facility that I have worked at though the Anesthesia MD may make VAD changes in the OR we all know it's either the surgery of TP cardio or VAd program coordinators that adjust the VAD most of the time

I have become quit an expert on the Debakey Medtech axial flow vad and will put my knowledge and experience to any resident. Im pretty competent managing hearmate I, thoratec, biomedicus and abiomed as well. I have studied probrably the same literature you have. I have managed many many VAD pt's, though not in OR. MOst of the time they crump post-op anyways and reg anesthesia is no where near unless they are bringing the pt back and still it is doubtful that anesthesia is going to be making any drastic VAD setting changes. Intra-op you have way more experience than I, but post op i can trouble shoot VAD related issues as well as many anesthesia residents. Anesthesia has little hands on with vads if any intra op in my experience, and when so they always collaborate with surgery or perfussion before pressing buttons, increasing flows or RPMS, switching drives or even manually pumping and changing filters if needed in emergencies.

Im my experience most anesthesia residents have no clue when It comes to the VAD. They may have a general understanding of how it works but they have no clue how to trouble shoot alarms, DisConnect pt and manually pump if needed, assess bladder filling to assess volume status, do flash tests to assess filling ect. Most of the time when receiving a pt from OR the balloon timing is totally off and needs adjustments anyway.

Again I understand that different facilities may have different services handling these issues so you may been the VAD GOD who knows. But most VAD pt's crump post-op and RN's manage VADS very well. Most VAD coordinators at facilities are RN's as well. I would rather the VAD coordinator RN make Vad changes sometimes rather than any MD. When your at the bedside 12hrs a day 4 x a week with a VAD or balloon pt you get to know that pt and his device very well and are able to recognize subtle changes either in the pt or device itself. Its all about experience man, either you have it, you want it or you are trying to get it. Your medical knowledge makes no difference when you are managing a pt and you are not an expert on the device. Quit inflating your education and expertise.

What type of VAD are we talking about in your hypotensive pt with a vad malfxn. What else is going on? Please understand that you do not know it all. Sometimes there is and will be someone out their with not as extensive an education as you that may be smarter than you and more competent than you at certain aspects of certain issues. Its ok to acknowledge that you dont know at all. Dont be to proud to learn a few things from this person like many of you are. Correct me if I am wrong but :

MD does not stand for = I know everything about every medical issue know to man and I am correct all the time, and am to proud to admit I need to learn and study something more in dept. Just curious thought it stood for Medical Doctor or something, maybe Im wrong.

OK, the bashers are back, I've been sitting in a clandestine corner, but I'm now locked and loaded.

Nitecap, what the f-u-c-k is your objective here? I'm not gonna bore you with my crudentials, nor do I feel the need to post same.

That being said, why do you post your "crudentials"? What is the objective? Do you recall our last interaction? I'm ready to return to that.

Your "skills" bore me. How would you like it if I posted all my "skills" on a CRNA/RN forum board? What would that accomplish? Why would I be at a CRNA/RN forum boasting my "skills", other than with malicious intent?

I do not understand why bashers come to an MD forum and post bashing posts.

Arent there women's clubs? Men's club's? Hunting clubs? Fishing clubs? Can't med-students/residents/practicing anesthesiologists have their own forum, rightly named the STUDENT DOCTOR NETWORK?

JWK is a seasoned professional. Why doesnt he post offensive, malicious posts? Why doesnt Trinity, a CRNA in my previous group, post offensive posts? Is there a degree of professionalism they have that you have missed?

Like I said in our last long interaction, what is your objective here???? Why are you here???