tips on dealing with CRNAs

[Mman]

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Hmm... NO. As long as they are working under my license (i.e. direction or supervision), their privileges end where I say.

Sort of. If they are credentialed to perform a procedure in a hospital, they aren't working "under (your) license", but under their's. You are responsible for directing the anesthetic care, but the ultimate answer is it depends who they work for. If they are hospital employees that the hospital says can do a certain procedure, well let's just say it isn't as completely cut and dry is if they aren't credentialed to do something.

 

[Consigliere]

was it unclear what I said? Or do you have a lot of experience directing CRNAs that suggests otherwise? Because we employ our own CRNAs and if they didn't get along well with us they'd have to go find another job. It's pretty much that simple.

That's how we roll. Only way to do supervision as far as I'm concerned. First off, we don't hire anyone that we catch even a vibe of an attitude from. If our CRNAs do get mouthy or disrespect ANY anesthesiologist they are immediately terminated with extreme prejudice.

 

[SitraAchra]

That's how we roll. Only way to do supervision as far as I'm concerned. First off, we don't hire anyone that we catch even a vibe of an attitude from. If our CRNAs do get mouthy or disrespect ANY anesthesiologist they are immediately terminated with extreme prejudice.

 

[G-Man82]

I like where I am. I worked with CRNAs when I did some work at University of Miami's hospital. Those CRNAs are used to doing whatever they want because frankly they're let loose to do so. They'll do everything short of central lines and regional (neuraxial excepted) in the OR. With 4 rooms, all ASA PS 3-4 patients, it was nearly impossible to not let them get away with it because I'd have to see the next one in holding or go extubate in another OR if I was lucky enough to make it there prior to extubation. One of them though, got so mouthy with me, that I kicked her out of the OR, since it was my only room towards the end of the day.

That got the administration's attention. She got a slap on the wrist for insubordination, though. Disappointing.

Where I am now, as an attending, I work mostly with AAs if I don't have residents. It is a night and day difference.

Advocate for AAs to be granted permission in your state. They're allowed in Florida, but at UMiami, the nurse lobby is so strong that they're not hired and leadership doesn't really care as long as the money rolls in.

 

[Consigliere]

That got the administration's attention. She got a slap on the wrist for insubordination, though. Disappointing.

Where I am now, as an attending, I work mostly with AAs if I don't have residents. It is a night and day difference.

Advocate for AAs to be granted permission in your state. They're allowed in Florida, but at UMiami, the nurse lobby is so strong that they're not hired and leadership doesn't really care as long as the money rolls in.

I'm surprised she even got that vs. you getting lectured on being a "team player."

 

[Shouldawouldacouldas]

I haven't been supervising much at my gig, mostly doing solo but will start supervising CRNAs more and more. Any of you veterans have tips on dealing with CRNAs? From what I hear from this group there are quite a few "militant" CRNAs that like to give attitude to new attendings. How do you establish a good relationship with these clowns and at the same time making them respect you as the physician. If I could do solo forever I would but just not possible. I also don't want to have a cordial relationship with them because I want to work here for a long time.

Your partners will know who the strong CRNAs are and who the weak ones are. If I get a call to come to the OR from one of my strong CRNA's , then I know that something bad is happening. I don't mind getting called frequently by the weaker ones. I treat them respectfully. If they want to do something different, I listen to their suggestion and reasoning, and then I decide accordingly. Never be so arrogant that you do not listen to others because you do not know everything. When I first got out of residency, I learned many little tips and tricks from experienced CRNA's. If the CRNA wants to do something more conservative with respect to the airway or monitoring, then I usually will go more conservative because they have to be comfortable too with the plan.

The CRNAs are not our employees, but if we don't want someone to continue practicing, we can get them fired. The 'cowboy CRNAs' are usually the recently graduated male CRNAs who have not had a near disaster from their cockiness. The best CRNA's and best anesthesiologists are the ones who know their limits and know that they need to call for help.

 

[G-Man82]

I'm surprised she even got that vs. you getting lectured on being a "team player."

I framed it as her deliberately flouting evidence based medicine and in a way causing harm to a patient. Plus, I knew I wasn't staying there and had already got my job. I had no one to impress and was there earning some extra cash during fellowship. I ran the case by a senior attending and chief who told me to log it in the event reporting system. Essentially I was asked to write her up so that there's a paper trail. The acting chief at the time seemed to be trying to rein them in and wanted the evidence. One guy, however, said he was "pro-CRNA" and served as their liaison to the physicians. His remarks to me were along the lines that "she's a late person, can handle herself and doesn't need her hand held." Clearly, I disagreed. I later found out that she is a DNP and at one point introduced herself as "Doctor" to patients before that was nipped.

Again, I love my AAs where I am. So much more pleasant to work with.


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