This will be fun

[WholeLottaGame7]

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I’d love for you to explain why I have no business doing this case. I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist. I’ll wayt.

By the way, one of the anesthesiologists (now gone) that was hired out of residency right before I got here had between 6 or 7 heart cases in residency. I had well over 10x that in my training. Which one of us is more qualified?[/QUOTE]

That's a clown story, bro.

A) Between 6 and 7? How do you do 6.5 cardiac cases?
2) No way you get out of residency without meeting your minimums (20 CPB, I think?). As opposed to SRNAs, where you can go on over to nurse-anesthesia.org and watch them argue over whether they can count simulation and standing in a corner watching residents provide an anesthetic in their case numbers.

Any field of medicine is too detailed to be great at everything. You're not done training to be an anesthesiologist when you finish residency. You've just demonstrated a minimum competency across a range of subspecialties. It is then up to you to continue your training (in fellowship or on-the-job) and become great at a few things. Saying "I want to focus on peds cardiac and leave complex OB up to someone better qualified" doesn't make me weak, it means I'm helping take the best care of patients possible. Thinking you're amazing at all things is both factually incorrect and dangerous for patients.

We had a CRNA at our institution recently write a letter that sounded extremely similar to the original post (but she was an older female CRNA), talking about how CRNAs should be able to practice to the "top of their abilities," and that she does central lines, OB, neonates, etc. The ironic part is that CRNAs here don't do CVLs or OB, and they kicked her out of the children's OR a decade ago because of poor care.

 

[deleted697535]

I believe he practices in an opt out state so he was doing the cardiac case independently. The anesthesiologist was doing his own cases, not supervising him.
That being said, any ct surgeon who is ok doing a case with a nurse as the sole anesthesia provider is crazy.

Maybe. But the way he worded it makes it sound like the anesthesiologist was supervisor. Why else would he check in?

 

[deleted162650]

so you did all of them alone as a resident right

I came off pump without my staff in the room 6mo into my CA-1 year. No bullsheet.

 

[flightnurse2MD]

Most of your post is false, which isn’t surprising.

Never said all anesthesiologists are lazy jerks who do nothing all day. But some are. I have a lot of respect for the ones I work with because they sit cases from time to time, mostly weekends. They provide anesthetics, which is what they were trained to do. And I know quite a few who haven’t provided an anesthetic in decades.

AANA membership isn’t mandatory. Never has been.

Who said I’m not proud to be a nurse? I think that’s a vital part of who I am as a provider and how I treat patients daily. If I wanted to be a doctor I’d have gone to med school. But I wanted to be a CRNA, and I’m proud of it. And none of that has anything to do with my ability to provide excellent, safe anesthetics to all ranges of patients and complexities of cases.

Proud to be a nurse? Then stop saying CRNA and say nurse anesthetist. 🙂

 

[flightnurse2MD]

Can and can not is not really a clinical aspect of medicine. it's more of a legal/political aspect. the only reason you can't just walk in and perform neurosurgery is because there are laws/rules against it. Same with assisted suicide. Anesthesiologists have more than enough skills to do so, but we aren't allowed to. There are many talented doctors abroad who perform the same procedures or same anesthetics that we do here, but they can't do it here without US approved credentials.

Many general surgeons go on to do further fellowship, minimally invasive, breast, thoracic, peds, etc etc. Why? To gain more experience, to be able to do a better job. There's a reason why OBGYNs are the worst surgeons, because their 5 year residency is split between OB and GYN, so they have way less surgical training. It's not always about what you cant and can do, but how well you can do it. Think about it, are CRNAs fighting for independent practice because they are pushing for better patient care? No. they do it for self beneficial reasons. How many college students became CRNAs because they want to be the best at anesthetizing patients so therefore they chose accomplish that goal by going to CRNA school instead of MD/Residency? If someone told you their goal is to be the best surgeon possible for the patients but is only willing to do 1.5 years of residency instead of 5.. would you believe them?

You see nurses, like me, go to medical school and even some nurse anesthetists as well. When have you ever heard of an anesthesiologist go to nurse anesthesia school for more training...?

 

[2Fast2Des]

You see nurses, like me, go to medical school and even some nurse anesthetists as well. When have you ever heard of an anesthesiologist go to nurse anesthesia school for more training...?

I'm actually thinking of going back to CRNA school, get my DNP, get that "heart of a nurse" since i only have the brain of a doctor right now, so I can practice at the top of my license and become a superstar double doctor Anesthesia provider. Why do fellowships after residency when less than 2 yrs of srna school will make you a periop master capable of all things those things those fellowships are meant for?

 

[MoMoGesiologist]

Supervised by surgeon or opt-out state.

I have seen cardiac surgeons using medical hospitalists (not intensivists) or even NPs to cover their patients in the CTICU. Why? Because the real (surgical) intensivists would not be pushovers.

What do you mean by "real surgical" intensivists? Are the anesthesia intensivists not real?

 

[flightnurse2MD]

I'm actually thinking of going back to CRNA school, get my DNP, get that "heart of a nurse" since i only have the brain of a doctor right now, so I can practice at the top of my license and become a superstar double doctor Anesthesia provider. Why do fellowships after residency when less than 2 yrs of srna school will make you a periop master capable of all things those things those fellowships are meant for?

The whole “heart of a nurse and brain of a doctor” irritates the s**t out of me. If anyone is qualified to make that statement it would be me and others like me. APNs need to start saying brain of a nurse practitioner or nurse anesthetist. It’s painfully obvious that nursing education is trying to blur the lines of a medical education with their new “residencies”, “fellowships”, and DNP programs.

 

[2Fast2Des]

What do you mean by "real surgical" intensivists? Are the anesthesia intensivists not real?

Anesthesiologist Intensivist is fake news, get with the program. Surgical Intensivists are tremendous and the best

 

[chocomorsel]

Or “I am Joe or Jane, part of your anesthesia team”.

Total BS.

Proud to be a nurse? Then stop saying CRNA and say nurse anesthetist. 🙂

 

[chocomorsel]

What do you mean by "real surgical" intensivists? Are the anesthesia intensivists not real?

He's an Anesthesia intensivist himself, so I bet he meant intensivists who specialize in surgical patients.

 

[deleted171991]

What do you mean by "real surgical" intensivists? Are the anesthesia intensivists not real?

Sorry. I meant surgical as in not IM-trained.

When we look at sudden tachycardia in a post-op patient, we see a potential surgical bleed. When some of our medical colleagues do the same, they see a PE, and focus on ruling that out (while the patient keeps bleeding). True story.

And no, I didn't mean that medical intensivists are not real intensivists either. What I mean was "real (and preferably surgical) intensivists".

 

[chocomorsel]

Sorry. I meant surgical as in not IM-trained.

When we look at sudden tachycardia in a post-op patient, we see a potential surgical bleed. When some of our medical colleagues do the same, they see a PE, and focus on ruling that out (while the patient keeps bleeding). True story.

And no, I didn't mean that medical intensivists are not real intensivists either. What I mean was "real (and preferably surgical) intensivists".

This reminds me in residency of a robot patient that became septic. Surprise surprise they nicked a bowel. Well she was clamped down and tachycardic but hadn’t gotten that hypotensive yet. They called me, as the women’s and kids pavilion was in the same building and I was in OB, to come and help them with a larger more proximal IV that the nurses couldn’t get.

I went in and the patient looked toxic and in severe abdominal pain. However the gyne “surgeons” were concerned about her hypoxia and wanted to R/O a PE. They needed the IV in order to shoot contrast and spin her.

I was like, OK. Really? That’s your first thought?

 

[Wiscoblue]

I’d love for you to explain why I have no business doing this case. I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist. I’ll wayt.

By the way, one of the anesthesiologists (now gone) that was hired out of residency right before I got here had between 6 or 7 heart cases in residency. I had well over 10x that in my training. Which one of us is more qualified?[/QUOTE]

You ‘had’ that many heart cases in your training? Whatever does it mean? Did you have any understanding of how cardiopulmonary bypass works? What is the mechanism of cardioplegia? What is systemic hypothermia and why do we use it? What are the consequences of hypothermia? What does the Krebs cycle mean to a CRNA ‘doing’ hearts? What is the mechanism of acidemia in off pump CABGs? What is the mechanism of hyperkalemia in acidemia? How does lasix work? How is atenolol excreted? How does the coagulation cascade work? What’s the difference between unfractionated and low molecular weight heparin? What is the molecular weight of hemoglobin? What happens to the oxygen dissociation curve in hypothermia? Why does nitrous oxide get into a bubble? How big will the bubble get?

When you ‘did’ a heart, did you actually know which lead of the EKG to look for ischemia in the patient with intraoperative problems?

When you diagnosed a Grade 4 MR in your heart, did you really know to differentiate it from a Grade 3? How does systemic vascular resistance affect MR? What is the relationship between coronary artery disease and MR?

I’ve seen CRNAs ‘do’ hearts. They intubate the patient and stand back. The surgeon then places the lines and charges for them. The surgeon tells them when to start dobutamine, nitro or nipride. He tells them how much heparin and protamine to give. He tells them when to hang blood. If that’s what you call doing hearts, congratulations! We are all wowed by our Crna colleagues who ‘do’ hearts and the depth of their understanding of cardiovascular physiology pharmacology and disease processes.

I bet that young anesthesiologist that was hired with 6-7 hearts under his belt actually knew what he was doing and why he was doing it. He knew the answers to all those questions or at least most of them. Experience means nothing without knowledge. CRNAs just don’t have what it takes to have an in-depth understanding of the science behind what they do. They might be skilled in the ‘art’ but they will never know why they do what they do.

And there’s the answer to what disqualifies you from doing a heart. Wayt no more.

 

[Psai]

We do more than 6-7 hearts a week. CRNAs making up stories to push their agenda, ain't nothing new.

 

[D P356]

I tried to click on the original link, but the website was taken down.