what exactly does supervising crnas entail?

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nitecap said:
You guys need to wake up from your MD dominant dream one day and realize that CRNA's administer all types of anesthetics all over the country with no MD/MDA looking over their shoulder telling them what stick of drugs to push or what knob to turn. It is your faded and cloudy understanding about what we are really capable of doing clinically that advances the CRNA profession. You guys that have the old oh just another ICU nurse mentality are just a helping hand ect when that really is a large misestimate of a CRNA's capability. The more you underestimate the less robust you lobby, the less you think CRNA's can really get done. Which in turn leads you guys all to be shocked when another state opts out, or when we dont have your back on a CMS issue, or when we don't agree to kneel down to your rules. AS well all of the aurguments you use while in your dream are all illegitiment as far as a real study claiming who is the safest provider. So please guys, hold out your arms, allow another bolus of STP and enjoy the dream, eventually someone will wake you up, wont be me.

As far as the AA issue goes heres a little piece of advice. IT makes whole lot of sense for you guys to totally control the market, and thats about the only sense it makes b/c it does not make finacial sence b/c AA's are paid the same for the most part. It does not at all make for a safer anesthetic b/c their are no studies what so ever comparing MDA's to CRNA's to AA's. And as well if the AA profession grows pretty soon it will be like the PA profession and you will have little Johnny's 4th grade homeroom teacher putting little johnny to sleep with only 24 months of training beyond her elementary education degree. So sure it makes more sense to bow out of the batltle, take the passive aggressive approach b/c you guys are not any stronger the the body of CRNA's mentally, emotionally and passionately. Once Get you 30 thoussand AA's as you want and you will see malpractice increase, deaths rise, you name it. No offense JWK, you have a plethora of experience, the AA I met online the other nite at Emory has a civil engineering degree with never a hands on pt care experience ever in her life. Never even looked in to a pt's mouth, never did anything. The experience gap is huge, and of course can be filled with years of practice but hate to pt that pt during the first year.


I looked into AA programs. Have you ever been to Emory, or Case Western's AA websit? Have you seen the pre-requisites? They require everything that pre-med does, and more.

And by the way, we're not talking the arm-chair science courses that MOST nursing students get away with. You know what I'm talking about too. I've taken post-bacc courses at two major universities and have a BA from another. And each have a BSRN program. But, let me tell you, the sciences are not the same as those required for pre-med and AA programs (some AA programs require the MCAT).

In fact, I just dropped (due to being a complete joke) a microbiology class (300 level, mind you) that I was taking as a post-bacc in preparation for a rigorous medical school journey. It was the one required of the nursing program, and was totally "arm-chair".

I switched out of it in favor of the microbio class that the actual science majors take. Big, big difference. And this applies to the organic chemistry that nurses take. NOT the same.

Sure, CRNA's have clinical skills. But, when it comes to the actual rigors of an academic curriculum, the AA's have to push through some very challenging science courses.

You mentioned this civil engineering major just waltzing into an AA program. Nice try. His/her degree may have been in CE, but that person would have MINIMALLY had to complete every medical school requirement, plus anatomy and physiology (separately), depending on the AA school. In addition, the MCAT would most likely been required (at the very least the GRE). So, don't misrepresent the reality.

So, just 24 months of anesthesia experience (some are like 26 or 28)?? How long did you spend learning anesthesia?? You need to do your homework before posting trash like that.

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the amazing disappearing act
 
Over the years, everyone will get the necessary experience.

What it boils down to is "who should be in charge?"

So, Who should be in charge?

Society will dictate....patients will dictate...the medical staff of hospitals will dictate.
 
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Who should be in charge?

Pts dictate, Hospital administrators dictate, provider availability dictates, economics dictates, the state of Medicare/Medicaid dictates.

As well which of the 2 0r 3 AA programs requires MCAT. I will compare courses at My program with any AA programs. You agreed there is an experience gap, by years most of the time. Sorry doubt Microbio 300 is gonna help you you the shiznit is slinging all over the place. Doubt you be thinking about that pitre dish with the gram - bacteria growing in it and the pattern it grew. Your aurgument is weak . Thank for supporting mine by acknowledging the exp. gap
 
nitecap said:
Your aurgument is weak . Thank for supporting mine by acknowledging the exp. gap

Of the 3 stool sitters that can be used:
1) new anesthesiologist
2) new CRNA
3) new AA

Answer 1 will have the most experience on stool sitting....if that is the only criteria you're going to use.
 
nitecap said:
Sorry doubt Microbio 300 is gonna help you you the shiznit is slinging all over the place. Doubt you be thinking about that pitre dish with the gram - bacteria growing in it and the pattern it grew. Your aurgument is weak .


Your lack of knowledge is the problem here. You can't be expected to understand something that you have no grasp of due to your lack of education. Your argument about microbiology for instance is pathetic. Can you tell me the difference b/w gram + and gram - sepsis and when one is more likely or what the difference in presentation or what the treatment is and why. If a surgeon wants to bring a pt to the OR for an acute abd. can you discuss the signs and symptoms of toxic shock with that surgeon and possibly save the pt. an unnecessary operation? Why are the blood cultures negative in these patients from time to time? I have had to do this recently and microbiology helped me in this instance. You are out of your league here and you don't even understand why?
 
I had a lady who was added on in the afternoon for a lap chole. She had severe COPD with an acute exacerbation...on the vent...developed pleural effusions...needed a chest tube...etc.

Surgeon wanted to take the gallbladder out for chronic cholecystitis because the primary care doc thought that the gallbladder may be contributing to the respiratory failure.

Review of US shows a relatively normal gallbladder (some sludege) and a HIDA scan showing slight decrease in EF with CCK.....consistent with ICU biliary dysfunction...patient on TPN.

Case could be done...and any anesthetist can do it with or without supervision...patient is tubed already....so plug and let the surgeon play.

Before bringing the patient down to the OR...I called the primary care doc to discuss the case. I suggested perc drainage if they really thought that the gallbladder was causing the respir...failure....

They thought that was a great idea...case cancelled....I think that is the part that an anesthesiologist is supposed to play....review the patient's medical status and assist in developing the best care for the patient...even if it doesn't involve the OR.
 
nitecap said:
Who should be in charge?

Pts dictate, Hospital administrators dictate, provider availability dictates, economics dictates, the state of Medicare/Medicaid dictates.

As well which of the 2 0r 3 AA programs requires MCAT. I will compare courses at My program with any AA programs. You agreed there is an experience gap, by years most of the time. Sorry doubt Microbio 300 is gonna help you you the shiznit is slinging all over the place. Doubt you be thinking about that pitre dish with the gram - bacteria growing in it and the pattern it grew. Your aurgument is weak . Thank for supporting mine by acknowledging the exp. gap


Only a nurse like yourself would make such an ignorant comment.
 
militarymd said:
I had a lady who was added on in the afternoon for a lap chole. She had severe COPD with an acute exacerbation...on the vent...developed pleural effusions...needed a chest tube...etc.

Surgeon wanted to take the gallbladder out for chronic cholecystitis because the primary care doc thought that the gallbladder may be contributing to the respiratory failure.

Review of US shows a relatively normal gallbladder (some sludege) and a HIDA scan showing slight decrease in EF with CCK.....consistent with ICU biliary dysfunction...patient on TPN.

Case could be done...and any anesthetist can do it with or without supervision...patient is tubed already....so plug and let the surgeon play.

Before bringing the patient down to the OR...I called the primary care doc to discuss the case. I suggested perc drainage if they really thought that the gallbladder was causing the respir...failure....

They thought that was a great idea...case cancelled....I think that is the part that an anesthesiologist is supposed to play....review the patient's medical status and assist in developing the best care for the patient...even if it doesn't involve the OR.


The problem with nitecap, like any technician, is that he/she believes that anesthesiology is nothing more than intubating, pushing propofol and waking up patients.
Would you ever expect any CRNA to bother doing what you did to keep that patient from undergoing what may have been an unnecessary surgery?
 
militarymd said:
I had a lady who was added on in the afternoon for a lap chole. She had severe COPD with an acute exacerbation...on the vent...developed pleural effusions...needed a chest tube...etc.

Surgeon wanted to take the gallbladder out for chronic cholecystitis because the primary care doc thought that the gallbladder may be contributing to the respiratory failure.

Review of US shows a relatively normal gallbladder (some sludege) and a HIDA scan showing slight decrease in EF with CCK.....consistent with ICU biliary dysfunction...patient on TPN.

Case could be done...and any anesthetist can do it with or without supervision...patient is tubed already....so plug and let the surgeon play.

Before bringing the patient down to the OR...I called the primary care doc to discuss the case. I suggested perc drainage if they really thought that the gallbladder was causing the respir...failure....

They thought that was a great idea...case cancelled....I think that is the part that an anesthesiologist is supposed to play....review the patient's medical status and assist in developing the best care for the patient...even if it doesn't involve the OR.


I dont disagree with the MDA role in pt care at all. And I do not at all think the 2 services are equal. Both have their perks. There is room for both however. Not anywhere in the nation are MDA's loosing jobs b/c CRNA's are taking them. Please come to that reality and realize that. You guys cant control the whole market, their is simply not enough of yall or enough AA's to provide service to everyone that deserves it. Yet you continue to try to control the market and continue to fail d/t realizing that the public, and those who represent them put the public first. and limiting CRNA practice based on invalid and biased studies will only hurt the constituents in the long run. It is blatently obvious of the motivation and politicians realize this clearly. Come on, trash talk the saftey of crna's yet promote an even less documented, less trained less experienced provider.

The ACT model works well, it is proven in literature and widely used in all states and profitable at that. If CRNA independence is what intimidates you please take a look at the states that have opted out of Medicare part A regulations. They are largely rural states that had poor access to providers so govoners made the choice that would benefit their people. Saying it is the wrong thing to do using bogus claims is just not morally right.
 
nitecap said:
I dont disagree with the MDA role in pt care at all. And I do not at all think the 2 services are equal. Both have their perks. There is room for both however. Not anywhere in the nation are MDA's loosing jobs b/c CRNA's are taking them. Please come to that reality and realize that. You guys cant control the whole market, their is simply not enough of yall or enough AA's to provide service to everyone that deserves it. Yet you continue to try to control the market and continue to fail d/t realizing that the public, and those who represent them put the public first. and limiting CRNA practice based on invalid and biased studies will only hurt the constituents in the long run. It is blatently obvious of the motivation and politicians realize this clearly. Come on, trash talk the saftey of crna's yet promote an even less documented, less trained less experienced provider.

The ACT model works well, it is proven in literature and widely used in all states and profitable at that. If CRNA independence is what intimidates you please take a look at the states that have opted out of Medicare part A regulations. They are largely rural states that had poor access to providers so govoners made the choice that would benefit their people. Saying it is the wrong thing to do using bogus claims is just not morally right.

Sounds like a change in tone here. If you recall, the people your arguing with here mostly are in favor of the ACT.
 
Isn't it time for your break, Nitecap? Why don't you go to the REPORT ROOM, munch on some of the pretzels that your fellow nurses brought, have a smoke, and simmer down. Don't worry about the patient--it's break time.
 
Sodak said:
Isn't it time for your break, Nitecap? Why don't you go to the REPORT ROOM, munch on some of the pretzels that your fellow nurses brought, have a smoke, and simmer down. Don't worry about the patient--it's break time.


Sorry sodak dont smoke, welcome to forum.
 
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nitecap, I'd just like to say that I don't have anything against nurses. And, as for CRNA's, I realize that you guys are well trained and a valuable member of the anesthesia community. I've dated two of them (and I'm just a pre-med!! lol)

But, you should be a bit more even handed regarding AA's, what the program prerequisites are, and the level of training they undergo. Having respect for others is pretty much key to getting along in this world, but you know that.
 
When one makes a comment about replacing all CRNA's with AA's sorry I have to state my aurgument.
 
nitecap said:
1. Sorry but I see the PA students as well as the Med students 1st and 2nd years and sorry they dont know their dinguses from there oral aperature when It comes to a pt.

2. Oh course they are all well trained and what not, yes. But If you put 1st year PA or even med student couldnt freaking manage even a ICU Nurses sick pt from the start. Most of the med students arent even making huge descisions right until residency I see it every day so I know im not mistaken on this.

Ive been a six month lurker in the forums, and by the way this site is wonderful for a 3rd year medical student. I should start by saying im not anti-anyone(well except for anti-dingus), I am definately team-model. I live in one of the those god-awful rural states that most people on this forum would rather never visit. :) My dad is a FP doctor in town of less than 2,000, he has no x-ray, CT, lab work etc....and must do physical exams at night by candlelight. :laugh: Any way ive rotated through several rural hospitals like my hometown where surgeons come in one day a week, do lapcholes, t&a's, etc. All CRNA provided anesthesa, while I dont think it is a perfect model, It is what needs to be done where im from. There are not enough MDA's, plain and simple. The CRNAs I worked with where all like 30 year vets and provided excellent care, but there is a difference in Knowledge base. Me probably being the annoying question monkey I am, ( and the fact that in the last year I have decided I really want to go into Anesthesia), the science background questions and Pharm questions I had went unanswered by everyone(lol even the surgeons for the most part, those crazy cutters.) There is a difference in knowledge, there has to be, NO BODY IS CRAZY ENOUGH TO CRAM THE FIRST TWO YEARS OF MEDICAL SCHOOL KNOWLEDGE DURING THERE FREE TIME. No not all of it is related to Anesthesia, but a lot of it is.

Sorry this is so long, but I wanted to address a couple of your statements because they are very common among nurses in all fields and I have had 2-3 similair conversations during my internal med rotation this month about this.

1.STOP ASSUMING MEDICAL STUDENTS ARE STUPID BECAUSE THEY CANT FUNCTION LIKE DOCTORS AND EXPERIENCED NURSES. 99% of the health care provider population has no Idea what MD training is. The learning and experience curve is steep. A 1st or 2nd year MD student is basically a 5-6th year college student. They lock you in a classroom with a huge pile of books and notes and say learn all this and we will test you every friday. It is not like nursing school where they combing classroom and hands on learning right away.(a couple of good friends of mine went into nursing.) 6months ago I had probably seen a couple dozen patients and felt incompetent(which i was) doing physical exams, couldnt start ivs, didnt know how to write orders, and yes couldnt tell a patients ass from his/her mouth. This has all changed and will continue to change over the next year and a half. We also have this thing called residency that is a minimum a 3 years, 80 hrs a week, and I'm just assuming that will erase a lot experience issues in general(unless ive totally misinterpreted how residency works).

Anyway sorry for the long post, give your medstudents a break, Ive learned just as much hands on stuff from CRNA(ivs, intubating), Surg techs(suturing, sterile procedure, tying), Floor nurses(orders, foleys,patient care, etc) as I have from my attendings, so PLEASE if you seen that scared little 2nd year student doing an afternoon of shadowing, dont ask him for narcotic pain management orders, and please dont assume he is a ***** if he would like to watch you start one iv or put in a foley before he gives it a try. Ive been lucky have been around great nurses early in my career and just want people to know how much of a difference you can make in creating a team atmosphere. :love:
 
despite the many threads on this interesting, hotly debated issue folks are still arguing about the same things. the CRNAs argue that their training is equal on some level with MDAs to qualify them to "practice medicine" independently, and MDAs argure that CRNAs are important but without justification to be usurping current supervison guidelines their profession was built on. so what is the issue here? to me, it is one thing...what is the standard that society expects from their independent practioners. Since the beginning of time it has, in one form or another, been a doctorate of medicine. so why all of sudden do nurses feel that standard is no longer necessary? to me i hear arrogance from CRNAs, and lack of respect for the training MDAs go through to earn their right to practice independently.

so this is the issue to me...why do MDAs have to go through their extensive training and nurses do not?

see next two threads
 
just for clarification purposes....

MDA
4 yrs undergraduate studies usually in biological sciences with classes in chemistry (2 semester), physics (2 sem), orgainic chemistry (2 sem), and biology (1 sem) (usually anatomy/physiology (2), microbiology (1) and biochemistry (1-2) are taken but not required by definition)

BSN
2 years of undergraduate studies with requisites in microbiology (1), chemistry (1), and anatomy/physiology (2), then 2 years of nursing courses. the nursing curriculum at univ. of MD has one science class (pathopharmocology and one health assessment (not history and physical) course. all other courses are specifically nursing duty related and not for the "practice of medicine".
http://nursing.umaryland.edu/programs/bsn/bsn-trad2.htm

MDAs then take the dreaded but necessary MCAT testing chemistry, physics, verbal reasoning, biology and organic chemistry.
I dont know if RNs have an entrance exam but doesnt look like it.

MDAs then go to medical school. In the first 2 years, contact hours (class time) are equivalent to 120 undergraduate credit hours. That's four years of undergrad crammed into 2 yrs. Classes include graduate level gross anatomy, biochemistry, physiology, genetics, immunology, history taking, behavioral science, microanatomy (histology), neurosciences (neuroanatomy and neurohistology), nutrition and statistics. That's the first year. The second year MDAs take pathology, pharmacology, microbiology, physical exam, clinical medicine, bioethics and preventive medicine.

Then we take a national exam (USMLE 1 assesses whether medical school students or graduates understand and can apply important concepts of the sciences basic to the practice of medicine.)

During 3rd year 50 out of 52 weeks are spent rotating on clinical wards in all primary care specialties (FP,peds,OBgyn,surg,IM,psych) averaging 60-80 hrs/week. fourth yr is spent mainly on elective except for sub internship in medicine and a neurology rotation at our school (36-44 weeks out of 52). MDAs then take a second national board exam (USMLE 2 assesses whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision.)

Then MDAs due one year of general internship in a variety of specialty rotations averaging 80 hrs/week then take USMLE 3 (assesses whether medical school graduates can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine.)

**BSNs wanting to apply to CRNA school work atleast one year in "acute care" taking orders from MDs (not practicing medicine), then take the GRE (which has nothing to do with medicine)**

Then MDAs participate in 3 years of clinical anesthesia training rotating in all specialities including pain managment, CCM, and regional anesthesia among others (avg 70hrs/week). then take the oral and written national boards for anesthiology.

CRNAs minimum is 1 year of "advanced nursing" classes (not medical school classes, not graduate school classes) Below curriculum taken from Drexel CNRA program.
http://www.drexel.edu/cnhp/nursing/grad_na_programs.asp

All these classes are for "advanced nursing" not "practice of medicine".

Anyway, CRNAs then spend 1 year (that's right just one year required) in clinical anesthesiology learning mainly from MDAs, and I assume fellow CRNAs.

continued...
 
So what's the point of all this? Obviously our training is vastly different, but this is the standard society has set. So what then justifies independent practice of nurse anesthetists? Should NPs also practice independently? Should PAs? Should we abolish the MD profession altogether based on the arrogant, misguided view of our CRNAs and their political underhandedness? Unabated nurses would want all advanced nurses to practice independently which would make MD training obsolete. I see no humbleness or respect in nursing agendas or rhetoric in this forum that they have any understanding of what it really takes to practice medicine independently. Maybe they should "make up" their own general surgery advanced nursing training and start practicing general surgery independently. why not? two years of post BSN sounds like it is enough to do anything. maybe neurosurgery should become a nursing specialty. why not?

So why should my opinion matter? I was a PA for 8 years before going to medschool. The more I learned, the more experience I gained, the more respect I had for the MD training model (eventhough i was doing about 90% of what my MDs were doing). I wasn't arrogant enough to think i could practice medicine independently, so I took responsibility for myself and am currently pursuing a doctorate in medicine to gain the right and privilege of practicing medicine independently. Now that I am in medschool it has more obvious than I thought as to why this extensive training is necessary. But how could I of truly known this if I hadn't done the training myself (which is why I feel in general CRNAs in this forum are arrogant). My training will be broad at first so I understand the vastness of human disease, then specific enough to become an expert in the field I choose. I will then be the gatekeeper of medical knowledge (along with my colleagues) so that the practice of clinical medicine and the development of research advancements can be safely passed on to generations of medical students to come.

there is a reason CRNA has the word nurse in it. it is not to degrade, but to be proud of the nursing heritage, etc. but recoginize that since the beginning of hippocrates nursing (or any variation of it) has not been the standard of care for independent medical practice that society has demanded. for that you need an MD plain and simple.
 
No one ever said that CRNA training is better than that of a MDA. Just stating that despite the number of years one has trained there have been no significant or valid evidence to support that one training and profession is less safe than the other. Plain and simple. One that does 2 yrs pre reqs, 2 yrs bsn courses, 2 yrs ICU then 2.5-3 years of CRNA school=8.5-9 total years of preperance can deliver an anesthetic just as safely as someone with 4yr undergrad, 4 med school, 4 residency = 12 yrs. Maybe it doent take that full 12 years to be a safe provider, who knows. Seems to be the case it we have 33 thousand CRNA's out there doing much of what MDA's do as far as the operative eperience goes.

And as far as the Nursing classes one talked about within those nursing classes are pt specific issues related to patho, different procedures and surgerys, OB, PEDS, Neonate. It is very pt popuation specific courses to go along with the clinical aspect of Nursing school.
 
nitecap said:
No one ever said that CRNA training is better than that of a MDA. Just stating that despite the number of years one has trained there have been no significant or valid evidence to support that one training and profession is less safe than the other. Plain and simple. One that does 2 yrs pre reqs, 2 yrs bsn courses, 2 yrs ICU then 2.5-3 years of CRNA school=8.5-9 total years of preperance can deliver an anesthetic just as safely as someone with 4yr undergrad, 4 med school, 4 residency = 12 yrs. Maybe it doent take that full 12 years to be a safe provider, who knows. Seems to be the case it we have 33 thousand CRNA's out there doing much of what MDA's do as far as the operative eperience goes.

And as far as the Nursing classes one talked about within those nursing classes are pt specific issues related to patho, different procedures and surgerys, OB, PEDS, Neonate. It is very pt popuation specific courses to go along with the clinical aspect of Nursing school.

You ever see a labrador on a leash, full of energy, looks like he just did a doggy crackrock, and his owner throws a ball about fifty yards?

Thats what I feel like reading this thread.

A crackrock labrador.
 
A triple mocha latte if I had to guess is damn near close to crack as far as the stimulatory effects. Ruff ruff ruff, bow wow. Unique analogy but not true.
 
when i saw the title of this link i thought they were going to talk about CRNAs.

http://www.aana.com/press/2003/052903.asp

i have always viewed CRNAs and AAs as having the same anesthesia specific training. As a PA I could do everything my doc did. There were some advanced skills I learned on the job, but that didnt take long. The important thing is that i was "under supervision". CRNAs dont have the corner on the market on what is taught in a 2 yr anesthesia program. It amazes me how the CRNA world twists reality. if the public really knew what little nurses learn in nursing school they wouldnt be separating the two educational programs. "CRNAs and anesthesiologists receive a minimum of seven and eight years of education and clinical experience respectively, all directly related to healthcare and anesthesia." that is B.S. That is the narrow minded, delusional thinking that borders on fraud and misrepresentation. If the public really knew that CRNAs get a four year undergrad degree (2 yrs of nursing with only one basic science class), and AAs get a four year undergrad degree (whose basic science pre reqs are tougher by the way) and they both get two years of job specific training, CRNAs are going to find themselves in the same category as AAs in that article. CRNAs can't count their one year of required acute care training because it is not governed or standardized by the eduational institution and laying claim to that experience as adding to their anesthesia specific training is once again fraud. A RN could work at a quiet ER or ICU and never have to do much but it would still count. MDAs need to do some serious educating for the public b/c nurses are cunning (ie liars) and they will pull the wool over your eyes if you are not careful. god this B.S. pisses me off !!! everyone knows what you get when a licensed MD shows up but the public has no idea of what they are getting when a CRNA shows up because of this political spin by nurses.
 
Well, let's not go too far. Nurses are wonderful.

Now if you want to compare the AANA to Al Qaeda, I'm down with that. :laugh:

threepeas said:
b/c nurses are cunning (ie liars) and they will pull the wool over your eyes if you are not careful. god this B.S. pisses me off !!! everyone knows what you get when a licensed MD shows up but the public has no idea of what they are getting when a CRNA shows up because of this political spin by nurses.
 
bullard said:
Well, let's not go too far. Nurses are wonderful.

Now if you want to compare the AANA to Al Qaeda, I'm down with that. :laugh:

i am refering to RN leaders. When i was a PA in Maryland the nursing lobbyist slandered PAs extensively to thrwart us gaining prescription priveleges. this went on for 3 years until someone in the state general assembly actually researched the negative claims nurses were making and barred their lobbying groups for fraud and misrepresentation. that year our prescription rights bill passed no problem. the rhetoric in this article just reminded me of those days.

i love nurses but their hierarchy is dangerous. they created professional avenues which sucked all the best nurses from primary nursing duties so they could pursue advanced nursing practices. nurses should of never been allowed to do that. RNs are the back bone of our healthcare system and they are in tremendous short supply. RNs for eons have maintained their role in medicine and have supported the public admirably. now the basic RN is being neglected for career advancement. the philosophy of medical practice and patient care between physicians and nurses is vastly different. RNs are never trained to do a history and physical, develop a differential diagnosis, investigate the DDx with tests, make a diagnosis and design and monitor a treatment plan. RNs recognize symptomatology and assign risk and report to the physician for treatment. They are not trained to problem solve what is causing the problem. they are trained to recognize problems. they are also trained to be the patient advocate and maximize comfort. why take a person trained in this way and then retrain them to think like physicians, and at the same time weaken our nursing force. it is shortsighted. if a RN orders a lab test, gives a medication that is not prescribed by a physician they are breaking the law by practicing medicine without a license. how is it that these same nurses, go to "nurse" graduate school and that rule doesnt apply anymore. PAs can only practice medicine because they are supervised and are considered "agents of the physician" and trained from the beginning in the medical model that physicians are trained. RNs have some how cunningly got themselves in a position to practice medicine unsupervised without going to medical school, and the public is not the wiser. its all politics and they will go as far they can.
 
threepeas said:
i am refering to RN leaders. When i was a PA in Maryland the nursing lobbyist slandered PAs extensively to thrwart us gaining prescription priveleges. this went on for 3 years until someone in the state general assembly actually researched the negative claims nurses were making and barred their lobbying groups for fraud and misrepresentation. that year our prescription rights bill passed no problem. the rhetoric in this article just reminded me of those days.

i love nurses but their hierarchy is dangerous. they created professional avenues which sucked all the best nurses from primary nursing duties so they could pursue advanced nursing practices. nurses should of never been allowed to do that. RNs are the back bone of our healthcare system and they are in tremendous short supply. RNs for eons have maintained their role in medicine and have supported the public admirably. now the basic RN is being neglected for career advancement. the philosophy of medical practice and patient care between physicians and nurses is vastly different. RNs are never trained to do a history and physical, develop a differential diagnosis, investigate the DDx with tests, make a diagnosis and design and monitor a treatment plan. RNs recognize symptomatology and assign risk and report to the physician for treatment. They are not trained to problem solve what is causing the problem. they are trained to recognize problems. they are also trained to be the patient advocate and maximize comfort. why take a person trained in this way and then retrain them to think like physicians, and at the same time weaken our nursing force. it is shortsighted. if a RN orders a lab test, gives a medication that is not prescribed by a physician they are breaking the law by practicing medicine without a license. how is it that these same nurses, go to "nurse" graduate school and that rule doesnt apply anymore. PAs can only practice medicine because they are supervised and are considered "agents of the physician" and trained from the beginning in the medical model that physicians are trained. RNs have some how cunningly got themselves in a position to practice medicine unsupervised without going to medical school, and the public is not the wiser. its all politics and they will go as far they can.

**********JET BOWS AND GENUFLECTS TO PROPHETIC POST****
 
nitecap said:
No one ever said that CRNA training is better than that of a MDA. Just stating that despite the number of years one has trained there have been no significant or valid evidence to support that one training and profession is less safe than the other. Plain and simple. One that does 2 yrs pre reqs, 2 yrs bsn courses, 2 yrs ICU then 2.5-3 years of CRNA school=8.5-9 total years of preperance can deliver an anesthetic just as safely as someone with 4yr undergrad, 4 med school, 4 residency = 12 yrs. Maybe it doent take that full 12 years to be a safe provider, who knows. Seems to be the case it we have 33 thousand CRNA's out there doing much of what MDA's do as far as the operative eperience goes.

And as far as the Nursing classes one talked about within those nursing classes are pt specific issues related to patho, different procedures and surgerys, OB, PEDS, Neonate. It is very pt popuation specific courses to go along with the clinical aspect of Nursing school.

the problem is nurse nitecap is that your training regiment and practice as a CRNA has been under the pretense that historically you have always been supervised by an MD. now you can practice independently but you haven't increased your training. that to me is a quality control issue of enormous proportions. in addition i dont think your AANA has rights to lay claim to safety numbers that were obtained while being supervised (regardless of the level). its like doing a small drug trial on safety and efficacy and determining the drug is safe, but years after being on the market and exposed to all the crazy population dynamics that drug was actually unsafe. if you want to transition from a dependent practioner (like you've been since 1880) to a independent practioner justify it with additional training. the medical doctor training model of today has been graduating independent practioners for almost 200years. how many years has your organization across the board put out licensed independent practioners? less than 5 and only in one field of medicine. god your arrogance ticks me off.
 
threepeas said:
the problem is nurse nitecap is that your training regiment and practice as a CRNA has been under the pretense that historically you have always been supervised by an MD. now you can practice independently but you haven't increased your training. that to me is a quality control issue of enormous proportions. in addition i dont think your AANA has rights to lay claim to safety numbers that were obtained while being supervised (regardless of the level). its like doing a small drug trial on safety and efficacy and determining the drug is safe, but years after being on the market and exposed to all the crazy population dynamics that drug was actually unsafe. if you want to transition from a dependent practioner (like you've been since 1880) to a independent practioner justify it with additional training. the medical doctor training model of today has been graduating independent practioners for almost 200years. how many years has your organization across the board put out licensed independent practioners? less than 5 and only in one field of medicine. god your arrogance ticks me off.


Damn an MDA calling a Nurse arrogant, talk about role reversal. And your drug trial comparison is garbage really. Seems that after 100 yrs of existance with generation after generation using that drug that someone by now would be able to prove that this drug is unsafe and that this other drug is way more safe. And dependent practitioner since 1880. Sorry man Dr. Mayo wasnt telling Alice Magaw (the mother of anesthesia)how many drops of ether to drip on the mask. Nor was Dr. Crile telling Agatha Hodgins how much ether and N20 to use. Back in these days no MD wanted to put the pt to sleep. So the whole dependent thing is bogus man, please do your research on the history. Similarly bogus like it is today. Back then you had Nurses administering anesthesia with no imput from surgery and def. no MDA. And today you still have the same thing. A CRNA practicing in rural podunct no where just needs that OK to administer the anesthesia from surgery. Once we have that order you can administer the anesthetic as you wish. Does not have the be route, dose, med, type whatever specific. Please dude dont try to challenge me on history of dependent practice b/c it is crap. Dependent in yes I need an order from an MD to administer the anesthetic. Doubt you will administer many anesthetics with surgery asking you to do so. Dont try to give me a History lesson man, you may learn a few things. Arrogance is the answer for nurses man, thats is why Nursing in general has not progressed as quickly as say nurse anesthesia. With more men entering Nursing that ever before nurses in general will be way stronger mentally, physically, emotionally and last but not least politically. WHy do you think the AANA is as robust as it is. Sorry man I give respect if I get it I dont give a damn if your a MDA, RN, JD, gargabe man, or president.

What borrowed numbers are you talking about as well. Since both work together so closely Id guess its pretty hard to do studies or judge saftey. There are just to many variable to consider. If the AANA's numbers are false than so are the ASA's. There is no way ACT groups could administer anesthesia safely to that many pts if both werent pretty damn safe.
 
nitecap said:
With more men entering Nursing that ever before nurses in general will be way stronger mentally, physically, emotionally and last but not least politically. WHy do you think the AANA is as robust as it is.


REALLY?
Are the women in nursing not mentally,physically, or emotionally as strong?
 
nitecap said:
Damn an MDA calling a Nurse arrogant, talk about role reversal. And your drug trial comparison is garbage really. Seems that after 100 yrs of existance with generation after generation using that drug that someone by now would be able to prove that this drug is unsafe and that this other drug is way more safe. And dependent practitioner since 1880. Sorry man Dr. Mayo wasnt telling Alice Magaw (the mother of anesthesia)how many drops of ether to drip on the mask. Nor was Dr. Crile telling Agatha Hodgins how much ether and N20 to use. Back in these days no MD wanted to put the pt to sleep. So the whole dependent thing is bogus man, please do your research on the history. Similarly bogus like it is today. Back then you had Nurses administering anesthesia with no imput from surgery and def. no MDA. And today you still have the same thing. A CRNA practicing in rural podunct no where just needs that OK to administer the anesthesia from surgery. Once we have that order you can administer the anesthetic as you wish. Does not have the be route, dose, med, type whatever specific. Please dude dont try to challenge me on history of dependent practice b/c it is crap. Dependent in yes I need an order from an MD to administer the anesthetic. Doubt you will administer many anesthetics with surgery asking you to do so. Dont try to give me a History lesson man, you may learn a few things. Arrogance is the answer for nurses man, thats is why Nursing in general has not progressed as quickly as say nurse anesthesia. With more men entering Nursing that ever before nurses in general will be way stronger mentally, physically, emotionally and last but not least politically. WHy do you think the AANA is as robust as it is. Sorry man I give respect if I get it I dont give a damn if your a MDA, RN, JD, gargabe man, or president.

What borrowed numbers are you talking about as well. Since both work together so closely Id guess its pretty hard to do studies or judge saftey. There are just to many variable to consider. If the AANA's numbers are false than so are the ASA's. There is no way ACT groups could administer anesthesia safely to that many pts if both werent pretty damn safe.

Thanks again, Nitecap, for your unwanted, unneeded propeganda on a

DOCTORS FORUM.

We know, we know. Nurses rule. Nurses know as much as doctors. Nurses provide just as good an anesthetic as doctors.

You win.

OK, folks, lets shut down the SDN anesthesia forum. No more need for anesthesiologists. We're done. :laugh: :laugh:

All kidding aside, I've been hearing your societies s hit since I finished residency in 1996. Seriously. The sky WAS falling back then. CRNAs were gonna take over anesthesia, the United States, and The Universe, in that order.

Funny how now, its 2006, and my ANESTHESIOLOGIST position is in higher demand now, more so than it was back in 1996, when THE SKY WAS FALLING.

The sky will never fall. If available, surgeons and patients will always opt for a doctor to be present for their anesthesia.

With all your spare time and obvious intelligence, you should divert your attention to studying for the MCAT.

For the 20,000th time, and I'm trying, believe me, to leave the cusswords outta this post, which is extremely hard given my Florida crackka roots,

please take your NURSE propeganda elsewhere.

We know. Nurses rule. We know.
 
threepeas said:
i am refering to RN leaders. When i was a PA in Maryland the nursing lobbyist slandered PAs extensively to thrwart us gaining prescription priveleges. this went on for 3 years until someone in the state general assembly actually researched the negative claims nurses were making and barred their lobbying groups for fraud and misrepresentation. that year our prescription rights bill passed no problem. the rhetoric in this article just reminded me of those days.

i love nurses but their hierarchy is dangerous. they created professional avenues which sucked all the best nurses from primary nursing duties so they could pursue advanced nursing practices. nurses should of never been allowed to do that. RNs are the back bone of our healthcare system and they are in tremendous short supply. RNs for eons have maintained their role in medicine and have supported the public admirably. now the basic RN is being neglected for career advancement. the philosophy of medical practice and patient care between physicians and nurses is vastly different. RNs are never trained to do a history and physical, develop a differential diagnosis, investigate the DDx with tests, make a diagnosis and design and monitor a treatment plan. RNs recognize symptomatology and assign risk and report to the physician for treatment. They are not trained to problem solve what is causing the problem. they are trained to recognize problems. they are also trained to be the patient advocate and maximize comfort. why take a person trained in this way and then retrain them to think like physicians, and at the same time weaken our nursing force. it is shortsighted. if a RN orders a lab test, gives a medication that is not prescribed by a physician they are breaking the law by practicing medicine without a license. how is it that these same nurses, go to "nurse" graduate school and that rule doesnt apply anymore. PAs can only practice medicine because they are supervised and are considered "agents of the physician" and trained from the beginning in the medical model that physicians are trained. RNs have some how cunningly got themselves in a position to practice medicine unsupervised without going to medical school, and the public is not the wiser. its all politics and they will go as far they can.


Do obviously you are 3 peas still in the POD. You need to open up and sprout man. First of all you say professional hierarchy of Nurses. Man take a look at the history of your own profession (MD). You guys have always and still do operate of that good ole boy law. MD's have controlled everything since the begining. Times are changing, hlth care is expensive, non-MD practitioners are being trained better than ever, the health care crisis looms, you guys simply cant controll every aspect of everything related to hlth care any longer. Most CRNA's are trained by MDA's man. And whats this whole medical model crap. Sorry if I go to CRNA school within a MDA residency and my attending is the same attending as the resident and we are both doing say a bowel resection that MD is going to teach that CRNA the same things he is going to teach that resident plain and simple. It would be unethical to not teach that CRNA something that may improve pt outcome. They teach. Same thing goes with a PA/NP. Say a NP/PA for a nephrologist. Those nephrologist teach the NP everything, what they like, how they think, problem solving approaches. Now you have NP/PA going into ICU, ordering CVVHD, HD, and handling things that Nephrologist does. No that PA is not as knowledgable as the Renal guy, no they dont have a Certified Registered NP -renal degree. These nurses arent being trained by freaking mary poppins.

As a PCA in sugery as a student I saw PA's all the time practically do the entire total hip man. Shoot after assisting his ortho pod attending for 10 yrs doing thoussands of procedures there was no doubt in my mind that he could do it.

And man in the Critical care arena nurses write half the orders anyway. Sorry man, not gonna wait to bolus amio with a pt in Vtach when cardio is freaking snoring and not picking up the phone. You must be young man, maybe a med student, I wont hold your lack of intellegent arguement against you, after all you are still in your pod. Miracle grow man, speed it up.
 
jetproppilot said:
Thanks again, Nitecap, for your unwanted, unneeded propeganda on a

DOCTORS FORUM.

We know, we know. Nurses rule. Nurses know as much as doctors. Nurses provide just as good an anesthetic as doctors.

You win.

OK, folks, lets shut down the SDN anesthesia forum. No more need for anesthesiologists. We're done. :laugh: :laugh:

All kidding aside, I've been hearing your societies s hit since I finished residency in 1996. Seriously. The sky WAS falling back then. CRNAs were gonna take over anesthesia, the United States, and The Universe, in that order.

Funny how now, its 2006, and my ANESTHESIOLOGIST position is in higher demand now, more so than it was back in 1996, when THE SKY WAS FALLING.

The sky will never fall. If available, surgeons and patients will always opt for a doctor to be present for their anesthesia.

With all your spare time and obvious intelligence, you should divert your attention to studying for the MCAT.

For the 20,000th time, and I'm trying, believe me, to leave the cusswords outta this post, which is extremely hard given my Florida crackka roots,

please take your NURSE propeganda elsewhere.

We know. Nurses rule. We know.

Man Im not even trash talking you. Out of almost all posters of here I respect you and a few others. NOt being militant either man, sorry for taking a stand. Sometimes mentally weak and definitely uneducated as far as practice rights and politics goes need to get put in their place and I choose to be the one to do it.

I believe there is more than enough room for both and am a ATC advocate totally. The perspective that some of these posters have is very weak and very for the most part nieve. Hey if they are going act all big b/c they are a MD or in med school its time for them to wake up and realize they are not all that. As always my motor is never even running until started a poster. Look at the beginning of the thread, I started off rather informative. It did take a turn for the worse but hey Im not a passive aggressive kinda guy. I speak my word and suport my cause. So JPP again I respect you as a poster, dont at all wanna get into it again with you. If you havent realized by now I am hear to stay. Way younger than most of you so will prob be around in the long run way longer. SO chill man, and realize that Im not taking and shiznit straight up.

anyways I rest my case for now.
 
nitecap said:
So the whole dependent thing is bogus man, please do your research on the history. Similarly bogus like it is today. Back then you had Nurses administering anesthesia with no imput from surgery and def. no MDA.

well i did my research. remember a little court case in 1917. I think it was Frank vs. South. And I quote from the AANA website:

Frank, the holder of a medical degree, made the diagnosis and determined the treatment that were the medical judgments to be made. The court held that Hatfield (CRNA) was not engaged in the illegal practice of medicine because she worked "under his direction and supervision."

So since atleast 1917 it appears CRNAs have been practicing under supervision and that is what has kept them out of jail mon frere. You need to get YOUR facts straight! So my original post above still stands.

As far as my drug analogy: CRNAs have not practiced independently until recently in rural areas and in states that have "opted out". This is a recent event. 90% of your safety records has been under supervision. Therefore the small percentage of you that have been practicing independently for a short period of time is likened to a drug that appears ok in small clinical trials but has not tested the true test associated with widespread use. Therefore dont go cocking off just yet.

Regarding your completely sexist remark about men in the field of nursing (read nitecap post above) you sound like quite the cro-magnum man. i am sure you charm all the ladies with that attitude.

anyways...i think i have made some good points in my previous posts from which i have heard a bunch of yada yada. I wish it didnt have to be like this. i love midlevel practioners and support any individual who wants to be better at their trade. but i think this current movement of RNs going to grad "nursing" school at the expense of sucking the bedside RN ranks dry, and CRNAs being allowed to practice medicine without a medical license is just unhealthy, and it reeks of irresponsibility. Other options need to be explored. I think I am pretty much done with this topic. I vomited all my opinions for the moment. Maybe someone will make me sick again tomorrow.



 
threepeas said:
well i did my research. remember a little court case in 1917. I think it was Frank vs. South. And I quote from the AANA website:

Frank, the holder of a medical degree, made the diagnosis and determined the treatment that were the medical judgments to be made. The court held that Hatfield (CRNA) was not engaged in the illegal practice of medicine because she worked "under his direction and supervision."

So since atleast 1917 it appears CRNAs have been practicing under supervision and that is what has kept them out of jail mon frere. You need to get YOUR facts straight! So my original post above still stands.

As far as my drug analogy: CRNAs have not practiced independently until recently in rural areas and in states that have "opted out". This is a recent event. 90% of your safety records has been under supervision. Therefore the small percentage of you that have been practicing independently for a short period of time is likened to a drug that appears ok in small clinical trials but has not tested the true test associated with widespread use. Therefore dont go cocking off just yet.

Regarding your completely sexist remark about men in the field of nursing (read nitecap post above) you sound like quite the cro-magnum man. i am sure you charm all the ladies with that attitude.

anyways...i think i have made some good points in my previous posts from which i have heard a bunch of yada yada. I wish it didnt have to be like this. i love midlevel practioners and support any individual who wants to be better at their trade. but i think this current movement of RNs going to grad "nursing" school at the expense of sucking the bedside RN ranks dry, and CRNAs being allowed to practice medicine without a medical license is just unhealthy, and it reeks of irresponsibility. Other options need to be explored. I think I am pretty much done with this topic. I vomited all my opinions for the moment. Maybe someone will make me sick again tomorrow.





Supervision though man, please define. If today you think a surgeon actually supervises a CRNA you are mistaken. You may here the occassional I need him a little deeper ect. But surgery does not develope the overall anesthesia plan. Supervision is a iffy word that really misleads many peeps especailly residents and med students to believe that CRNA's can make no independent decisions makes them think that we have to ask the surgeon/MDA if it is ok to scratch our balls. And that is simply not the case. Even in the ACT model if the CRNA is down stairs doing GA and the MDA is upstairs doing OB you make it sounds like the CRNA calls the MDA to ask if I can give X drug or if I can emerge or extubate.
 
nitecap said:
Do obviously you are 3 peas still in the POD. You need to open up and sprout man. First of all you say professional hierarchy of Nurses. Man take a look at the history of your own profession (MD). You guys have always and still do operate of that good ole boy law. MD's have controlled everything since the begining. Times are changing, hlth care is expensive, non-MD practitioners are being trained better than ever, the health care crisis looms, you guys simply cant controll every aspect of everything related to hlth care any longer. Most CRNA's are trained by MDA's man. And whats this whole medical model crap. Sorry if I go to CRNA school within a MDA residency and my attending is the same attending as the resident and we are both doing say a bowel resection that MD is going to teach that CRNA the same things he is going to teach that resident plain and simple. It would be unethical to not teach that CRNA something that may improve pt outcome. They teach. Same thing goes with a PA/NP. Say a NP/PA for a nephrologist. Those nephrologist teach the NP everything, what they like, how they think, problem solving approaches. Now you have NP/PA going into ICU, ordering CVVHD, HD, and handling things that Nephrologist does. No that PA is not as knowledgable as the Renal guy, no they dont have a Certified Registered NP -renal degree. These nurses arent being trained by freaking mary poppins.

As a PCA in sugery as a student I saw PA's all the time practically do the entire total hip man. Shoot after assisting his ortho pod attending for 10 yrs doing thoussands of procedures there was no doubt in my mind that he could do it.

And man in the Critical care arena nurses write half the orders anyway. Sorry man, not gonna wait to bolus amio with a pt in Vtach when cardio is freaking snoring and not picking up the phone. You must be young man, maybe a med student, I wont hold your lack of intellegent arguement against you, after all you are still in your pod. Miracle grow man, speed it up.

as far as MDs controling stuff #1 the MD profession has diffenently screwed up some things along the way no doubt, but has nothing to do with the specific points i made regarding the topic of this thread. stay on point. why shouldnt we as MDs control most things. we do all the research and and train the hardest and longest. there has to be that safety net of supervision though from the peeps that are the best trained. and for now and for the last couple of hundred years it has been MDs/DOs.

i have no problem with midlevels as already mentioned just the cocky ones who want to practice independently without the best training available.

Nurses who write orders are breaking the law.
A nurse who gives amiod for Vtach is simply following ACLS protocol and doesnt need an order.

i am 37 yo with 3 kids and one on the way. i am a second year medstudent and still work part time. i have been a PA in CCM/ER/and trauma for 8 years. I have a M.S. in Physiology and published basic science bench research. I have a B.S. in psychology. you are such a tool.
 
nitecap said:
Do obviously you are 3 peas still in the POD. You need to open up and sprout man. First of all you say professional hierarchy of Nurses. Man take a look at the history of your own profession (MD). You guys have always and still do operate of that good ole boy law. MD's have controlled everything since the begining. Times are changing, hlth care is expensive, non-MD practitioners are being trained better than ever, the health care crisis looms, you guys simply cant controll every aspect of everything related to hlth care any longer. Most CRNA's are trained by MDA's man. And whats this whole medical model crap. Sorry if I go to CRNA school within a MDA residency and my attending is the same attending as the resident and we are both doing say a bowel resection that MD is going to teach that CRNA the same things he is going to teach that resident plain and simple. It would be unethical to not teach that CRNA something that may improve pt outcome. They teach. Same thing goes with a PA/NP. Say a NP/PA for a nephrologist. Those nephrologist teach the NP everything, what they like, how they think, problem solving approaches. Now you have NP/PA going into ICU, ordering CVVHD, HD, and handling things that Nephrologist does. No that PA is not as knowledgable as the Renal guy, no they dont have a Certified Registered NP -renal degree. These nurses arent being trained by freaking mary poppins.

As a PCA in sugery as a student I saw PA's all the time practically do the entire total hip man. Shoot after assisting his ortho pod attending for 10 yrs doing thoussands of procedures there was no doubt in my mind that he could do it.

And man in the Critical care arena nurses write half the orders anyway. Sorry man, not gonna wait to bolus amio with a pt in Vtach when cardio is freaking snoring and not picking up the phone. You must be young man, maybe a med student, I wont hold your lack of intellegent arguement against you, after all you are still in your pod. Miracle grow man, speed it up.

Heres a way-too-eloquent reply to this.

Nitecap, you've been at this forum a long time. Problem is, you only decide to contribute when you sense controversy. Most of the time on this forum, there is no controversy. Posters come and go. Long-time posters continue to contribute real-life applicable information, clinical, business, and the like.

Day in and day out there is useful information exchange among clinicians. Not only amongst doctors, but also amongst CRNAs and AAs.

JWK is an AA, and a respected, long time contributor. People listen to his posts with respect.

Trinity Alumnus is a CRNA (and as an aside has been accepted to med school) whose posts are full of information about clinical scenerios, and the anesthesia business.

And then there you...who only posts in controversial threads, never posts anything full of information amongst colleagues, always defending yourself and your chosen profession.

Dude, do you have an inferiority complex or something? Where is your opinion on the renal protection thread? Or the MY MOST MEMORABLE MOMENTS thread? Or countless WHATS-BETTER, GA or REGIONAL threads? Why do you feel it necessary to hang out on a designated-doctor thread, and post only when you see controversy? You're obviously reading this forum frequently since you are a part of EVERY controversial thread. So why don't you contribute in the mean time, albeit positively?

KNOW WHY?

BECAUSE YOU ARE A PROPEGANDA HOUND. Your behavior represents political undertones, a clandestine presence known to just about every profession on earth. No matter what profession a human being picks, theres gonna always be a group of people nipping at your heels, telling you what a s hit profession you have chosen.

Why are you here, really? You and I have been here before. But I'm gonna ask you again, why are you here? Why do you choose to only contribute when controversy arises? Why dont you contribute to the relevant, clinical threads, and tell us about your experiences? Your clinical contributions?

Judging from your lack of relevant posts and your plethora of propeganda posts, one can only surmise that you are an AANA terrorist. Dude, we know about the AANA. We know how "powerful" you are.

Problem is, the AANA can be as "powerful" as it wants to be...problem is, surgeons and patients will always want a doctor involved in the anesthesia. If that werent the case, I'd be out of a job right now, since this debate has been full-tilt ever since I can remember.

I can assure you that SDN was not created so paraprofessionals could infiltrate with their propeganda. Rather, it was created so people in a certain profession could utilize the internet for cordial interaction with peers amongst a specialty. Sometimes heated, yes. But totally propeganda filled, no.

Look at your posts. Only defense posts. Only in defense of yourself, and CRNAs. Dude, this is the wrong forum for you to try and disseminate your propeganda.

Ever consider changing your posting style? Ever consider trying to become a respected poster like some of your peers, Trinity Alumnus and JWK?
 
MDA's rule eveything
 
nitecap said:
So what you want an award or something. Same here, I love MD's just not cocky ones and I will not let a cocky one talk down upon myself. As far RN's writing orders n critical care man you should really wake up. Electrolytes, pain meds, antiemetics, insulin, it is done all the time. Most of the time we are thanked for writing them. NO a RN is not gonna write for Chemo or something, but sometimes you just have to put the pt's interest first and write.

i dont want a reward, but i wanted to save you the time of trying to profile me like you did in your previous post.

The orders you are talking about are 99% of time protocol orders written by the director of the CCM.

The only reason you feel i am talking down to you is because you are either short in stature or short in self-esteem.
 
jetproppilot said:
Heres a way-too-eloquent reply to this.

Nitecap, you've been at this forum a long time. Problem is, you only decide to contribute when you sense controversy. Most of the time on this forum, there is no controversy. Posters come and go. Long-time posters continue to contribute real-life applicable information, clinical, business, and the like.

Day in and day out there is useful information exchange among clinicians. Not only amongst doctors, but also amongst CRNAs and AAs.

JWK is an AA, and a respected, long time contributor. People listen to his posts with respect.

Trinity Alumnus is a CRNA (and as an aside has been accepted to med school) whose posts are full of information about clinical scenerios, and the anesthesia business.

And then there you...who only posts in controversial threads, never posts anything full of information amongst colleagues, always defending yourself and your chosen profession.

Dude, do you have an inferiority complex or something? Where is your opinion on the renal protection thread? Or the MY MOST MEMORABLE MOMENTS thread? Or countless WHATS-BETTER, GA or REGIONAL threads? Why do you feel it necessary to hang out on a designated-doctor thread, and post only when you see controversy? You're obviously reading this forum frequently since you are a part of EVERY controversial thread. So why don't you contribute in the mean time, albeit positively?

KNOW WHY?

BECAUSE YOU ARE A PROPEGANDA HOUND. Your behavior represents political undertones, a clandestine presence known to just about every profession on earth. No matter what profession a human being picks, theres gonna always be a group of people nipping at your heels, telling you what a s hit profession you have chosen.

Why are you here, really? You and I have been here before. But I'm gonna ask you again, why are you here? Why do you choose to only contribute when controversy arises? Why dont you contribute to the relevant, clinical threads, and tell us about your experiences? Your clinical contributions?

Judging from your lack of relevant posts and your plethora of propeganda posts, one can only surmise that you are an AANA terrorist. Dude, we know about the AANA. We know how "powerful" you are.

Problem is, the AANA can be as "powerful" as it wants to be...problem is, surgeons and patients will always want a doctor involved in the anesthesia. If that werent the case, I'd be out of a job right now, since this debate has been full-tilt ever since I can remember.

I can assure you that SDN was not created so paraprofessionals could infiltrate with their propeganda. Rather, it was created so people in a certain profession could utilize the internet for cordial interaction with peers amongst a specialty. Sometimes heated, yes. But totally propeganda filled, no.

Look at your posts. Only defense posts. Only in defense of yourself, and CRNAs. Dude, this is the wrong forum for you to try and disseminate your propeganda.

Ever consider changing your posting style? Ever consider trying to become a respected poster like some of your peers, Trinity Alumnus and JWK?

As my clinical experience is broadened believe me I will post more. I take in all the info in those posts though, believe me. I have learned quite a bit here. Just face it I may respect all you guys as posters, teachers, experience sharers what ever but when It comes to MDA - CRNA politics, practice rights, litigations ect you guys will never in a million years want to hear my point. We will always disagree and be at odds on these issues, its inevitiable. I will become more involved in clinical posts as my schooling progresses, ****ttt. AS my feelings will most likely only grow stronger as I grow as a practitioner and professional. Just consider me to all ways put in my 2 cents from the CRNA camp. If if offends you to have someone stand up for what they believe and to have someone state different views than you than use ignore. Have a good nite.
 
nitecap said:
So what you want an award or something. Same here, I love MD's just not cocky ones and I will not let a cocky one talk down upon myself. As far RN's writing orders n critical care man you should really wake up. Electrolytes, pain meds, antiemetics, insulin, it is done all the time. Most of the time we are thanked for writing them. NO a RN is not gonna write for Chemo or something, but sometimes you just have to put the pt's interest first and write.
RN's in the unit don't write orders - they follow protocols.

JWK <<<<< enjoying watching this one explode over the last 24 hours or so. All my points are getting made, so I'm doing my part to limit the overall length of the thread before it gets shut down. :laugh:
 
Ok JWK forgot you had all that ICU nursing experience.
 
nitecap said:
As my clinical experience is broadened believe me I will post more. I take in all the info in those posts though, believe me. I have learned quite a bit here. Just face it I may respect all you guys as posters, teachers, experience sharers what ever but when It comes to MDA - CRNA politics, practice rights, litigations ect you guys will never in a million years want to hear my point. We will always disagree and be at odds on these issues, its inevitiable. I will become more involved in clinical posts as my schooling progresses, ****ttt Im not even in the clinical phase of my program man, my tone regarding these types of post will probrably never change though. AS my feelings will most likely only grow stronger as I grow as a practitioner and professional. Just consider me to all ways put in my 2 cents from the CRNA camp. If if offends you to have someone stand up for what they believe use ignore. Have a good nite.

No offense taken, if youre posts were coming from someone with experience, like JWK et al.

Unfortunately, by your own admission, you have no experience,

which in essence riddles your posts down to the propeganda file. Thats all your posts represent, Nitecap. Nurse propeganda.

Anesthesia/Family Practice/Internal Medicine/Ophthalmology/Microsoft/Oracle/Dell will always have that one file in their offices where they put propeganda media/emails/posts.

Nitecap has just secured immortality in that file.
 
nitecap said:
As my clinical experience is broadened believe me I will post more. I take in all the info in those posts though, believe me. I have learned quite a bit here. Just face it I may respect all you guys as posters, teachers, experience sharers what ever but when It comes to MDA - CRNA politics, practice rights, litigations ect you guys will never in a million years want to hear my point. We will always disagree and be at odds on these issues, its inevitiable. I will become more involved in clinical posts as my schooling progresses, ****ttt Im not even in the clinical phase of my program man, my tone regarding these types of post will probrably never change though. AS my feelings will most likely only grow stronger as I grow as a practitioner and professional. Just consider me to all ways put in my 2 cents from the CRNA camp. If if offends you to have someone stand up for what they believe use ignore. Have a good nite.

Dude,

You mind as well be me, a Florida crackka, applying for an MC position on BET.
 
nitecap said:
As my clinical experience is broadened believe me I will post more. I take in all the info in those posts though, believe me. I have learned quite a bit here. Just face it I may respect all you guys as posters, teachers, experience sharers what ever but when It comes to MDA - CRNA politics, practice rights, litigations ect you guys will never in a million years want to hear my point. We will always disagree and be at odds on these issues, its inevitiable. I will become more involved in clinical posts as my schooling progresses, ****ttt Im not even in the clinical phase of my program man, my tone regarding these types of post will probrably never change though. AS my feelings will most likely only grow stronger as I grow as a practitioner and professional. Just consider me to all ways put in my 2 cents from the CRNA camp. If if offends you to have someone stand up for what they believe use ignore. Have a good nite.
Oops sorry, I can't resist.

How much of your time in your "anesthesia education" is being spent on learning politics and how much on useful things like taking care of patients? You're not doing clinicals yet, but you've already been well indoctrinated by your "professional" organizations with all the PC rhetoric that's considered appropriate by your associations. How many classes in CRNA school are non-clinical ones like CRNA History and How to Bash MD's 101, and AA's - The Easy Target 102? I wonder, because I'll tell you, I see and hear this same crap over and over and over. There must be a textbook y'all use, because every one of you uses the same arguments pretty much verbatim.
 
Sorry I can't take it anymore -- It's propaganda.

Otherwise I'm with you jet. BTW I actually think we should have more training in the politics of medicine. We as a group have not been effective in our dealings with allied health groups, government, insurance companies and even each other.

Cheers
 
nitecap said:
Block 1 Block 2 Block 3 Block 4 Block 5 Block 6
Chemistry for Anesthesia Practice X
Pathology for Allied Health X
Clinical Biochemistry X X
Prof. Aspects of Nurse Anesthesia X X X X X
Anatomical Science X X X X
Physics for Anesthesia Practice X
Immunology for Allied Health X
Human Physiology X X X
Pharmacology in Advanced Practice X X X X X
Principles of Anesthesia X X X X X
Genetics for Allied Health X
Human Anesthesia Simulation X X X X
Integrated Anesthesia Concepts X X X X
Biomedical Instrumentation X X X
Radiology for Allied Health X
Health Research Methods X
Clinical Orientation X X
Nervous Systems X X

5 of 6 blocks = professional aspects class in only the first year. The gross anatomy, nervous systems, radiology are taken with the med students. Phys /bio chem we use same text.

Can one please answer this honestly. early one said that in med school they were required to memorize a ton of stuff. So If one uses the same texts, have the same profs, the same notes, hears the same lecture, uses the same cadavers and cross sections in lab as a med student might that non med student know just as much anatomy, neuro science, phys as that med student. Last I heard you didnt need a specific title behind your name to memorize anatomy, to memorize bio chem and neuro pathways, to memorize enzymes, neurotransmitters ect. If you guys wanna bark that a resident trains longer than a CRNA than of course I agree. But to say that only a MD can learn these basic sciences is false. Anyone can pick up a book and learn. Same goes with anesthesia theoretical knowledge. If one picks up big Miller and studies the hell out of it and knows all the theory in great detail than all that one needs is the experience which eventually they will get.

Dude,

since its been decided that your posts are propaganda only, please limit your posts to a paragraph or less, since I, and I'm sure everyone else, kinda trail off after your second sentence....

please take your propaganda filled posts to MDsDONTGIVEA SHI T.com.
 
jetproppilot said:
Dude,

since its been decided that your posts are propaganda only, please limit your posts to a paragraph or less, since I, and I'm sure everyone else, kinda trail off after your second sentence....

please take your propaganda filled posts to MDsDONTGIVEA SHI T.com.


Just gonna dodge your trash talking man. Do we really want to do this. You know I can go the distance.
 
nitecap,

Do you feel that CRNAs require any type of MD supervision or collaboration? Do you feel that there are any anesthesia/pain services that should be provided by an anesthesiologist physician only?

If the answer to one or more of the above questions is no, then you are are miles apart from what a large majority of MDAs and MDs in general think, and you are not going to convince any of us by listing the title of your courses.

You must know, btw, that the crappiest medical schools in the world have the most impressive sounding courses of all?

The range of your educational experience is not the same as that of an MDA, though I do not dispute that you may have learned a lot both during and after training and may be good at what you do. The piunt is that the training of CRNAs is not equivalent to that of MDAs, however your professional organizations blur the distinction between the specialties by unethically manipulating information (such as including nursing work experience to count the same as RESIDENCY :eek: in computing length of training). Your organizations are systematically using LEGISLATIVE pressure/lobbying, rather than training, to extend your scope of practice. This is a practice that we do not support.
 
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