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matrix123
08-10-2009, 01:10 AM
What does everyone think of AA vs. CRNA? I'm not a nurse yet, so the shorter route would be to do the AA. However, I'm not sure if that is the right choice. Anybody has any guidance and wisdom regarding this? Thanks in advance!

DaveCRNA
08-10-2009, 01:40 AM
Um....did you look at the name of this website??:fish:


Seriously, though, do some searching around the site, you will find info from the perspective of the CRNA, and a few AAs on this site. By and large though, the opinion will be that the shortest route is not always the correct route!!! CRNA is the way to go!

Good luck, whatever you decide.

*edited to temper my 1st pissy response*

gasaholic
08-10-2009, 04:14 AM
something smells rotten in Denmark.....


SDN troll?

MisterMister
08-10-2009, 07:40 AM
GhT-8G0apio

gasaholic
08-10-2009, 08:10 AM
"i was a banana gatherer 2 years ago"

bwah ahahahaha

awesome!

MmacFN
08-10-2009, 11:10 AM
Here are some simple things to think about.

- AAs cannot work in every state in the USA, only CRNAs can

- CRNAs can work independent of anesthesiologists while AAs are assistants to anesthesiologists. This is very limiting for AAs but not CRNAs.

- CRNAs are 40000 strong in the USA, equal to the number of anesthesiologists. AAs may be in the 2000 range now. With healthcare reform coming AAs are on tenuous ground whereas CRNAs are much more flexible to meet needs.

The difference is int he name. Do you want to be trained as an assistant or be trained to be independent?




What does everyone think of AA vs. CRNA? I'm not a nurse yet, so the shorter route would be to do the AA. However, I'm not sure if that is the right choice. Anybody has any guidance and wisdom regarding this? Thanks in advance!

skipaway
08-10-2009, 11:17 AM
Do you even want to be a nurse? Just asking, as if you do not get into CRNA school...that is what your fallback will be.

MmacFN
08-10-2009, 11:18 AM
Awesome question.

Skip you rock.


Do you even want to be a nurse? Just asking, as if you do not get into CRNA school...that is what your fallback will be.

jimmybridget
08-10-2009, 11:28 AM
Do you even want to be a nurse? Just asking, as if you do not get into CRNA school...that is what your fallback will be.


Great point. A lot of people don't ask themselves this question before they attend nursing school with "high hopes"

Eugenius
08-10-2009, 01:13 PM
Exactly. Good point guys and Mike awesome breakdown. I knew of numerous students who knew right away that they wanted to do CRNA their first semester in school. They weren't getting stellar grades then, so maybe they reconsidered. It's serious business and people need to make an informed decision.

radrn2001
08-10-2009, 10:44 PM
Friggin' hilarious!

matrix123
08-11-2009, 02:42 AM
First of all, thanks guys for all your inputs. The issue is not whether I could or could not get into NA school. Only I know my potential and there is NO DOUBT that I can get in. My Science is GPA 3.76 and my cumulative is 3.71. I tutored Organic Chem, Gen Chem, and Biology all premed series to predent, premed, and prenursing students in college. I was Premed at that time, but due to my mom's diagnosis and suffering with breast cancer, I was tremendously affected and distracted. Also during that tumultuous time, I was already concurrently enrolled into an accelerated Resp. Program while taking Biochem., genetics, molec., and couple of other major science courses. I finished the Resp program in 6 months along with those enrolled 18 credit hours of university classes that semester. I did this so that I can gain some clinical experience when applying for med school. However, this was interrupted by that tragic event. This occurrence changed everything, and I had to stay back to help and be by her side. I was depressed for a time, and was just too exhausted to keep going with my premed ambitions. I then just worked as a respiratory therapist after witnessing the death of my mom until now when I am finally ready to move on. However, I feel I'm too old to pursue the path of a medical doctor. So now, I am kinda fighting against time. If I choose the CRNA route, I have to go back to finish a BSN program (accelerated) which will take a year which would start next Fall. And then, I have to get at least 1 yr of ICU experience BEFORE I can even apply. But who is to say that I would be hired as an ICU nurse right out of school? So.. waiting almost a year to START BSN, then another year for BSN program, then assuming best case scenario that I can work immediately in an ICU setting which puts another year ( now 3yrs already), then I can finally apply which would be another year before I can get in putting it at FOUR YEARS vs. being DONE with anesthetist school AA route with 1 yr to spare. And just think of the many times I wouldn't have to wipe poop! :)

Currently there are 16 States and DC where AAs can work. This number will undoubtedly grow with time. In fact, I called Locumtenens agency and asked them about hiring AAs. They did say that they are not doing that yet, BUT added that they will be soon w/in a year or two which means that it's growing. Job outlook is also considered excellent just like CRNA. Starting out is around
120K, little lower than CRNA which I agree that CRNAs do deserve due to their 1 yr of clinical requirement that was not imposed on the AA. But still not a bad starting salary for the AA, and with the 3yrs I save in becoming an AA, that salary will increase due increased experience. Concerning working under an MDA, I'm not sure if that is all bad since the responsiblility will be shared. Concerning the differences and similarities bwt CRNAs and AAs, here is a good unbiased article.

http://www.rmgh.net/index.php?option=com_content&view=article&id=477&catid=37:newsletters&Itemid=100008

I think academically speaking, AAs may even trained on a higher level in their undergrad years. Clinically, AAs are weaker, however, I don't think that cannot be learned once they're in the program that requires 2500 clinical hours.

In conclusion, MDAs, CRNAs, and AAs will eventually be all on the same team! So it's all good! Thanks again! Good luck to all and sorry for the life story!

eileen2010
08-11-2009, 07:19 AM
First of all, I am sorry for the loss of your mother. You sound like you have weighed the pros and cons of both AA and CRNA. That being said, you asked for an opinion on a forum dedicated to Nurse Anesthesia. Of course you will get our pro-crna advice. Only you can make the decision that will affect the rest of your life. Good luck to you in whatever career you chose. Either way, your mother would be proud of you.

Eileen

MmacFN
08-11-2009, 03:28 PM
Yah.. that is an "unbiased" article. Your killin me.

No it isnt.

Now let me answer you.


If I choose the CRNA route, I have to go back to finish a BSN program (accelerated) which will take a year which would start next Fall. And then, I have to get at least 1 yr of ICU experience BEFORE I can even apply. But who is to say that I would be hired as an ICU nurse right out of school? So.. waiting almost a year to START BSN, then another year for BSN program, then assuming best case scenario that I can work immediately in an ICU setting which puts another year ( now 3yrs already), then I can finally apply which would be another year before I can get in putting it at FOUR YEARS vs. being DONE with anesthetist school AA route with 1 yr to spare. And just think of the many times I wouldn't have to wipe poop! :)

Sorry about your mom. Now brace for reality.

All i read here is that you are looking for the easiest way out. You dont want to be an RN, you have no idea the value of the training OR the clinical experience and are clearly ensconced in the standard stereotypes of RNs. In essence, you are totally clueless yet here you are telling ME that the article you posted (total bullshit BTW) written by a pro-AA MD is unbiased. Geesus, could you have sounded more ignorant? That is rhetorical.

Your last sentence is incredibly telling. All you care about is when you will be done and making money. Forget the shitty training.


Currently there are 16 States and DC where AAs can work. This number will undoubtedly grow with time. In fact, I called Locumtenens agency and asked them about hiring AAs. They did say that they are not doing that yet, BUT added that they will be soon w/in a year or two which means that it's growing. Job outlook is also considered excellent just like CRNA.

AAs who work in practice where there are CRNAs make the exact same wage. Now, CRNAs who work independently can DOUBLE that wage. The national average is 140K for CRNAs working in teams.


Starting out is around
120K, little lower than CRNA which I agree that CRNAs do deserve due to their 1 yr of clinical requirement that was not imposed on the AA.

It isnt an imposition. It is the difference between not knowing a goddamn thing about medicine and having years of training and at least one with critical patients. THAT is SIGNIFICANT.


But still not a bad starting salary for the AA, and with the 3yrs I save in becoming an AA, that salary will increase due increased experience.

So all you care about is money. good to know.


Concerning working under an MDA, I'm not sure if that is all bad since the responsiblility will be shared.

As an AA your an ASSISTANT. That isnt a 'fun term' or something. That is the title. THEY are responsible and your job is to follow their direction.


Concerning the differences and similarities bwt CRNAs and AAs, here is a good unbiased article.

http://www.rmgh.net/index.php?option=com_content&view=article&id=477&catid=37:newsletters&Itemid=100008

Total bullshit.


I think academically speaking, AAs may even trained on a higher level in their undergrad years. Clinically, AAs are weaker, however, I don't think that cannot be learned once they're in the program that requires 2500 clinical hours.

Not even vaguely accurate. The pre med classes (all of which I have taken and actually WAS accepted to medical school) are meaningless to anesthesia. How do I know? Im a CRNA done CRNA training, had tuns of RN experience and took all those classes. So i can actually tell you the difference whereas you are blowing smoke.

As for the "2500" clinical hours. Yah, thats BS. AA programs count hours from the time they arrive to the OR to the time they leave. CRNA programs count the hours ONLY while you are in a case. So we get MUCH more. MUCH more. While the AA students are learning what an IV is and how those funny stickers go on a chest, the SRNAs are learning anesthesia. In the same length program i might add.


In conclusion, MDAs, CRNAs, and AAs will eventually be all on the same team! So it's all good! Thanks again! Good luck to all and sorry for the life story!

No, no we wont. AAs are screwed with the new healthcare reform which will summarily end many of the traditional ACT practices across the country which cost a fortune but provide no more value. Moreover, I work WITHOUT MDAs and No AAs are allowed to work in the independent practice I am in.

So, again, sorry for your mom but please, get the facts before you pretend you know something about anesthesia models, practices and providers.

JadamR15
08-11-2009, 06:05 PM
Damn, this guy pissed Mike the f**k off.


As for the "2500" clinical hours. Yah, thats BS. AA programs count hours from the time they arrive to the OR to the time they leave. CRNA programs count the hours ONLY while you are in a case. So we get MUCH more. MUCH more. While the AA students are learning what an IV is and how those funny stickers go on a chest, the SRNAs are learning anesthesia. In the same length program i might add.

1. Any reason we don't count our hours like AAs, so as to make a apples to apples comparison to lawmakers and the public?

2. How do MDgas residents count their anesthesia hours?

JadamR15
08-11-2009, 06:09 PM
OP -


Concerning the differences and similarities bwt CRNAs and AAs, here is a good unbiased article.

http://www.rmgh.net/index.php?option...&Itemid=100008

Did you really think that was unbiased???

beekahx4
08-11-2009, 07:38 PM
Damn, this guy pissed Mike the f**k off.



1. Any reason we don't count our hours like AAs, so as to make a apples to apples comparison to lawmakers and the public?

2. How do MDgas residents count their anesthesia hours?


We have to now record hours spent studying, hours spent in clinical, hours spent on call and some other stuff. Our PD said the AANA is probably going to make it official next year I believe. Will give them better stats.

dontquit
08-11-2009, 07:56 PM
Alright...Mike got steamed and rightly so. I will try not to get so passionate about a field that I'm very passionate about...I think you can see the underlying theme here... WE LOVE OUR JOB!

Anesthesia Assistants aren't on the same playing field. If you go back in history, Nurse Anesthetists gave the first anesthetics and were very competent in doing so...google Alice Magaw...hundreds of doctors and nurses from around the world came to watch her deliver flawless anesthesia.

Anesthesia Assistants were born out of the Anesthesiologists need to have someone deliver anesthesia under their supervision without the threat of that same person going out and practicing on their own.
Even though they are recognized in 12 states...how many of those states' hospitals utilize them and what's the job market like. I review jobs on a weekly basis and on any given day, I can leave my job be hired the next day, closeby, not even having to move my family.

I have a friend who is an AA, his wife is a plastic surgeon here in town. He commutes almost 2 hours one way so that he can still work...are you getting the picture yet?

I commend you on your grades...well done! I would however recommend you don't try and make comparisons about things that you have no clue on. Instead, post some questions and let these kind people advise you of the pro's and cons according to how they see it.
I'm not sure of your age, but I know many a person who has gone back to med school and are doctors now, but I'm not sure that's a good plan.
Good luck in whatever you do, but remember....be passionate about it.

ethernaut
08-11-2009, 07:57 PM
We have to now record hours spent studying, hours spent in clinical, hours spent on call and some other stuff. Our PD said the AANA is probably going to make it official next year I believe. Will give them better stats.
yea, like THATs gonna be controlled. puleeze! no reason to attempt to quantify studying, other stuff, etc... people can make things up verrrrry easily. waste of resources IMO.

Skeebum
08-11-2009, 09:22 PM
I freely admit to being the pain in ass cynical pessimist when it comes to this stuff. If I submit my hours to my PD saying I spent 10 hours a week in independent study, and my classmates submit "documentation" that they spent 12 hours a week, and I have an academic "hiccup" the faculty will come back and bite me in the ass, telling me I am a slacker ...................... not a great idea IMO.

I completely and totally understand if the AANA wants to counter the AA's clinical hours argument. BUT, if we lower our standards on this point, what is next?

gasaholic
08-11-2009, 09:35 PM
hmmm, I still think there may be some SDN relationship here.

no one else thinks the OP may be a troll?

ethernaut
08-12-2009, 04:15 AM
hmmm, I still think there may be some SDN relationship here.

no one else thinks the OP may be a troll?
yea, and the fact that we haven't heard from him in over 2 days. occurrences like this seem very similar... ask ?, incite and flame, no OP responses thereafter. hmmm....

jwk
08-12-2009, 05:24 AM
Quick fact check, Mike-style...




If you go back in history, Nurse Anesthetists gave the first anesthetics and were very competent in doing so...google Alice Magaw...hundreds of doctors and nurses from around the world came to watch her deliver flawless anesthesia.

No, Long and Morton had that distinction - neither were nurses. There was no such thing as "flawless anesthesia" in that time period.



Anesthesia Assistants were born out of the Anesthesiologists need to have someone deliver anesthesia under their supervision without the threat of that same person going out and practicing on their own.

Incorrect again - Anesthesiologist assistants came along at a time when nurse anesthetists were being given certificates, not a degree, in anesthesia, and there was no such thing as a master's-degree level anesthesia provider. And, 2/3 of CRNA's work in a practice with anesthesiologists, so at some level, they are being "supervised" as well.



Even though they are recognized in 12 states...how many of those states' hospitals utilize them and what's the job market like. I review jobs on a weekly basis and on any given day, I can leave my job be hired the next day, closeby, not even having to move my family.


AA's are in 17 states plus DC. AA programs, like CRNA programs, have virtually 100% job placement.



I commend you on your grades...well done! I would however recommend you don't try and make comparisons about things that you have no clue on.

Ditto.

armygas
08-12-2009, 09:09 AM
Incorrect again - Anesthesiologist assistants came along at a time when nurse anesthetists were being given certificates, not a degree, in anesthesia, and there was no such thing as a master's-degree level anesthesia provider. And, 2/3 of CRNA's work in a practice with anesthesiologists, so at some level, they are being "supervised" as well..

JWK,

You keep saying this but I recently found out that initially AA programs were bachelor degree granting not master's (are you sure about your history?)



Anesthesiologist assistants: Committee member Michael P. Herndon, M.D., provided us with information about AAs. There are two schools, Emory University, Atlanta, Georgia, and Case Western Reserve University, Cleveland, Ohio. Since 1971, Emory has graduated 507 AAs, and Case Western Reserve has graduated 210 AAs since 1973, for a grand total of 717. Currently, 525 AAs practice in Georgia and 84 practice in Ohio. No other state has more than eight assistants in practice, and most states have none. Dr. Herndon states that 8 percent of Emory's graduates went on to medical school. These numbers were higher in the early years of the program. Almost 35 percent of Case Western's graduates went on to medical school when the AA degree was a bachelor of science/pre-medical degree. Since 1988 when the degree became a master's in medical science, fewer AAs have gone on to medical school after graduation.

http://www.asahq.org/Newsletters/2002/4_02/unruh.htm

MmacFN
08-12-2009, 09:17 AM
Not sure what residents do actually.

As for counting like AAs, well I just dont see the point. They intentionally did it that way to pretend they have alot of hours. It is just smoke and mirrors.


Damn, this guy pissed Mike the f**k off.



1. Any reason we don't count our hours like AAs, so as to make a apples to apples comparison to lawmakers and the public?

2. How do MDgas residents count their anesthesia hours?

MmacFN
08-12-2009, 09:20 AM
Changing the hours does not lower our standards. We still get much more clinical hands on hours than AAs that does not change.

In my logs we had to account for all kinds of hours, however, none of that was calculated into the final number of hours. This is only related to clinical time in the OR.

So, as i understand it, our hour count wont actually change. The AANA is trying to get an idea of how many hours the average students spends in each category. I doubt there will be a total which is all the hours combined but a break down from clinical to other etc.



I freely admit to being the pain in ass cynical pessimist when it comes to this stuff. If I submit my hours to my PD saying I spent 10 hours a week in independent study, and my classmates submit "documentation" that they spent 12 hours a week, and I have an academic "hiccup" the faculty will come back and bite me in the ass, telling me I am a slacker ...................... not a great idea IMO.

I completely and totally understand if the AANA wants to counter the AA's clinical hours argument. BUT, if we lower our standards on this point, what is next?

armygas
08-12-2009, 09:44 AM
JWK,

I read your crap on SDN about how AAs had a master's degree "20 years" before the AANA even thought about it..... come to find out this is not even close to being true.

Your reply?

jwk
08-12-2009, 02:44 PM
JWK,

I read your crap on SDN about how AAs had a master's degree "20 years" before the AANA even thought about it..... come to find out this is not even close to being true.

Your reply?
Emory has always been a master's degree program since it graduated it's first class in 1971. The Case program started out as a bachelor's degree and changed to a master's in the early 80's, again, well before CRNA's were getting master's, and well before the requirements for CRNA students to have a bachelor's degree and a year of critical care experience.

armygas
08-12-2009, 03:14 PM
Emory has always been a master's degree program since it graduated it's first class in 1971. The Case program started out as a bachelor's degree and changed to a master's in the early 80's, again, well before CRNA's were getting master's, and well before the requirements for CRNA students to have a bachelor's degree and a year of critical care experience.
Case changed in 1988

armygas
08-12-2009, 03:19 PM
Just so you know JWK, the University of Hawaii stood up the master's degree for nurse anesthesia in 1973 (Ira Gunn .... Army.... Hoooah)

armygas
08-12-2009, 03:31 PM
Wow,

Just did some research and come to find out that the first AA program was at CWRU with the first class entering in 1971 into a BACHELORS degree program...... Here is the original article:

armygas
08-12-2009, 03:32 PM
Here is the original proposal of the idea:

armygas
08-12-2009, 03:33 PM
After reviewing the evidence, I do believe that Nurse Anesthetist introduced the master's degree at the same time....(GO ARMY)!!!

armygas
08-12-2009, 03:44 PM
Emory has always been a master's degree program since it graduated it's first class in 1971. The Case program started out as a bachelor's degree and changed to a master's in the early 80's, again, well before CRNA's were getting master's, and well before the requirements for CRNA students to have a bachelor's degree and a year of critical care experience.

You still gonna spit that lie???

I can guarantee you that by 1974 there were more master's prepared nurse anesthetist than AAs.

How about a bet?

armygas
08-12-2009, 03:49 PM
HAAAAHAHAHAH!!!

I was wrong! Nurse anesthestist were the FIRST to receive master's degrees! COL Clark was responsble for this in 1969!!!!



Sep 1969 A cooperative graduate program was established by the U.S. Army's Tripler General Hospital, Honolulu, and the University of Hawaii. Graduates of this program received a master's degree in nursing with a major in biophysical pathology and certification to practice anesthesiology nursing. Six ANC officers graduated from this program.


Tripler's program was the first and then after this coop, the University of Hawaii made it their standard in 1973.

So JWK, your reply?

armygas
08-12-2009, 03:59 PM
Ira Gunn and Mildred Clark were responsible for standing up the Tripler program, Ira went to Tripler to begin the program in 1965 and with COL Clark's support graduated master's prepared nurse anesthetist in 1969 and each subsequent class at Tripler received master's degrees. So it appears that there were at least 4 times the number of master's prepared nurse anesthetist in 1971 versus master's prepared AAs.

For those interested, here is a nice piece written by Ira Gunn on COL Clark.
http://www.aana.com/WorkArea/downloadasset.aspx?id=18280


Still gonna spit that garbage JWK?

armygas
08-12-2009, 06:10 PM
Just another point, 55% of current CRNAs hold a Master's Degree.

That is at least 15000 CRNAs with Master's Degrees.


19.4% of all CRNA employed full time or part time hold diploma certificates, but you know what? These people will be retiring in the next few years.

24.8% have a Bachelors, and 1.2% hold a doctorate.

LouisiAnimal
08-12-2009, 06:27 PM
Army you are the man

jimmybridget
08-12-2009, 06:47 PM
Army you are the man

I concur

stanman1968
08-12-2009, 08:14 PM
And, 2/3 of CRNA's work in a practice with anesthesiologists, so at some level, they are being "supervised" as well.

Now I am doing my case after preoping my patient placing any line blocks etc etc myself and the anesthesiologist is doing the same for there patient, just HOW am I being supervised? Not by any legal or practical definition of the word.

droopy1592
08-12-2009, 09:24 PM
Ouch... Guess that AA argument was just thrown out of the window.

MmacFN
08-13-2009, 06:20 PM
And then there was One.

Bwhaha....

man never come to a gun fight with a wiffle ball bat.

I guess the ASA lied to the AAs about all that.. how could that be? They know everything... gee, wonder what else they lied about?

Oh... I know, wait till i post about the attempt of the AAs in NM to get independent practice and forward it to my buddy Roger Moore... Yah, that is right. I have the bill that the AAs tried to pass giving them indy practice. Maybe I will also post it on SDN.

Good luck.

jwk
08-13-2009, 08:04 PM
Just another point, 55% of current CRNAs hold a Master's Degree.

That is at least 15000 CRNAs with Master's Degrees.


19.4% of all CRNA employed full time or part time hold diploma certificates, but you know what? These people will be retiring in the next few years.

24.8% have a Bachelors, and 1.2% hold a doctorate.

So 44.2% hold either a bachelor's or certificate only. Not quite half, but close.

jwk
08-13-2009, 08:06 PM
Oh... I know, wait till i post about the attempt of the AAs in NM to get independent practice and forward it to my buddy Roger Moore... Yah, that is right. I have the bill that the AAs tried to pass giving them indy practice. Maybe I will also post it on SDN.

Good luck.

Post it here - I'd like to see it. It certainly isn't on the list of bills for the current session of the New Mexico Legislature.

MmacFN
08-13-2009, 08:12 PM
It was defeated last session.

Once i get a chance to type it all out i will for sure.



Post it here - I'd like to see it. It certainly isn't on the list of bills for the current session of the New Mexico Legislature.

armygas
08-14-2009, 02:14 AM
So 44.2% hold either a bachelor's or certificate only. Not quite half, but close.

Well since CWRU only changed over to a master's in 1988 I wonder how many AAs currently do not have a master's degree?

rubyrn36
08-14-2009, 02:56 AM
Well technically by all accounts....THE SURGHEONS where the original people giving anesthesia...
until they decided that the patient would benefit and there would be better outcomes from a "dedicated anesthetiser"

and it began....

and Alice was reported to have "perfected" the ether drop method...





Quick fact check, Mike-style...



No, Long and Morton had that distinction - neither were nurses. There was no such thing as "flawless anesthesia" in that time period.



Incorrect again - Anesthesiologist assistants came along at a time when nurse anesthetists were being given certificates, not a degree, in anesthesia, and there was no such thing as a master's-degree level anesthesia provider. And, 2/3 of CRNA's work in a practice with anesthesiologists, so at some level, they are being "supervised" as well.



AA's are in 17 states plus DC. AA programs, like CRNA programs, have virtually 100% job placement.



Ditto.

jwk
08-14-2009, 05:08 AM
It was defeated last session.

Once i get a chance to type it all out i will for sure.

Nothing in the last session either. Nice try, no cigar. Better check your sources.

MmacFN
08-14-2009, 08:42 AM
J

I am well informed and have the bill in front of me. Once i have time I will make the post in the public forum about AA attempts to get independent (of MDAs) practice.

Im sure it will go over great with all the MDAs who read this board.


Nothing in the last session either. Nice try, no cigar. Better check your sources.

droopy1592
08-14-2009, 08:46 AM
It was defeated last session.

Once i get a chance to type it all out i will for sure.

Email to me the scans. I have software that will type out the scanned info as long as the font isn't crazy.

gasaholic
08-14-2009, 08:56 AM
Here is some information:

HB 536 The Anesthesiologist Assistant Bill. This
bill it its original form would have expanded the Scope
of Practice for AAs and allowed them to practice
throughout the state. Currently the Scope of Practice
is that an AA can assist an anesthesiologist in the
development and implementation of an anesthesia
care plan. They can only practice at the University of
New Mexico Hospital. The proposal would have
allowed AAs to develop and implement an anesthesia
care plan and practice throughout the state. In two
hearings we were able to stop the change of the scope
of practice and then to table the bill effectively killing
the effort for this session. This was accomplished
by the NMANA membership calling and emailing
members of the legislature and by 15 members giving
up a Sunday off and coming to Santa Fe to stand
and be counted in the committee hearing. It was
very effective and the bill was tabled.

COPIED FROM PAGE 3 BELOW:

http://www.nmana.org/El_Sol_NMANA_Summer_2009.PDF

gasaholic
08-14-2009, 08:58 AM
http://legis.state.nm.us/Sessions/09%20Regular/bills/house/HB0536.pdf

armygas
08-14-2009, 09:02 AM
Wow, "develop and implement".........

Sure looks like an attempt to gain independence to practice "throughout the state".

So now the ASA's monster is going to eat them. This is great!

gasaholic
08-14-2009, 09:05 AM
the fact that they are fighting for independence is a big "f**k you" to the A$A.

the A$A board must be looking at each other going ---> :eek2: what did we do????

droopy1592
08-14-2009, 09:05 AM
:Flush:

I never posted it but I was thinking that after AAs grew in numbers and if they claim that their education is equivalent to a CRNA's that they would eventually go against the ASA and try to be independent practitioners. What would be their title then?

dontquit
08-14-2009, 05:13 PM
Technically...surgeons gave anesthesia??? Hmmm...I think that would be really difficult to drop ether...then go back and do surgery...pt wakes up...drop ether..then do surgery again...Maybe I'm wrong.

J-Dubya
08-14-2009, 05:21 PM
Technically...surgeons gave anesthesia??? Hmmm...I think that would be really difficult to drop ether...then go back and do surgery...pt wakes up...drop ether..then do surgery again...Maybe I'm wrong.

I think this why you see nurse anesthetists appear so early on the scene.

It's my understanding that in these early cases the head surgeon would be the one doing the cutting and would not give the ether/chloroform/whatever. Another surgeon would administer the anesthetic. Right away it was clear that no MD wanted to be "stuck" giving the gas, and since this role really fits better under nursing, it was only natural that these early docs tapped nurses for this role.

rubyrn36
08-15-2009, 11:23 PM
Technically...surgeons gave anesthesia??? Hmmm...I think that would be really difficult to drop ether...then go back and do surgery...pt wakes up...drop ether..then do surgery again...Maybe I'm wrong.


Hence the desire for better outcomes...

drnurse
08-17-2009, 09:02 AM
CRNA's tend to be very dismissive and critical of the AA profession, when in reality the AA serves a very valuable part as a midlevel anesthesia provider, alonside CRNA's. Both CRNA's and AA's are good, and have positive things to offer in the realm of anesthesia. Seems VERY hypocritical to me IMO the attitude towards AA's.

I mean come on- creating videos calling AA's monkeys, right after Anesthesiologists used that exact same concept and applied it to CRNA's. It seems like CRNA's fight for their rights, by putting down other healthcare providers who provide a useful anesthetic service and have something to bring to the table...

yoga
08-17-2009, 10:42 AM
This is such a futile discussion. What you don't seem to understand is that we do NOT need another anesthesia provider in this country. Nurse anesthetists can practice without supervision, but AA's can't. So CRNAs are simply more marketable, along with consistent data validating safe practice and competitive reimbursement.

CRNAs and AAs do not compete. In my mind, AAs are just another way for anesthesiologists to make money without having to do anesthesia.

PLEASE, if you are not a doctor or nurse, change your sign in name. Those of us who are doctors (of any kind) and nurses have worked hard to be able to use those designations. If you are not one, you are a fraud.

Jan Mannino, CRNA, JD (earned them both)

FutrCRNA
08-17-2009, 10:44 AM
...if they claim that their education is equivalent to a CRNA's...

But they don't claim it's equivalent. They claim it's better ...because of all their "pre-med" courses. Whatever. I took all the pre-med courses, too - as did many others on this board.

drnurse
08-17-2009, 01:05 PM
Of course AA's are needed. They are another source of anesthesia providers, and can supplement CRNA's. The stereotype of a lazy doctor does not exist at all; it is completely made up and as ridiculous as the stereotype that CRNA's do all their degree training online and do clinical rotations in retirement homes or 10 bed units. Both are untrue The only reason CRNA's don't like them is they find them threatening and do not like the idea of a competing mid-level provider. If eliminating AA's means less people receive anesthesia needs, the AANA couldn't care less, because it means they have a less an income and power threat. By your logic, a CRNA has no use, since a physician can do all they do plus much more...but the point is that both are useful to meet growing anesthesia needs. AA's, however, are not running around claiming they are equal in ability to having the training of 4 years medical school, 4 years residency and 20,000+ clinical hours. They are willing to admit they have some limitations and do not have this notion medical school is a waste of money and knowledge, in the realm of anesthesia.

RAYMAN
08-17-2009, 04:19 PM
What more can a mda do in the OR that I can not? Lines, do them; regional, do that; hearts, do them; OB, do that; neuro, do that; manage difficult, complicated cases with multiple comorbidites...do that too. Whatever can you do in the OR that I can't? Preop and postop...ahh...do that too.

MmacFN
08-17-2009, 10:24 PM
Oh come now Mr Resident. (actually yer a doc) Dr. Resident. :)



Of course AA's are needed.

No they are not. What would be easier do you think? Creating a WHOLE new profession or just expanding CRNA and MDA programs? AAs were created for one reason and its 100% political. There have been less than 1000 of them in practice for about 25 years and now less than 2000. They are not changing or helping anything except to be 100% MDA slaves.


The stereotype of a lazy doctor does not exist at all

Ill say this. You just have not seen it, but MANY of us have. So yes, it is reality but maybe you are simply around those who work hard. I dont know.


The only reason CRNA's don't like them is they find them threatening and do not like the idea of a competing (AA) mid-level provider.

Well first, we are not midlevels. A midlevel cannot work independently and do the exact same service and get the same fee schedule. We can. That is the true difference in definition.

Second, we are not competing with them since they cannot compete with us. We are infinitely more flexible and can work independently and indy within an ACT as needed. An AA cannot do this by law. Moreover, when you are trained to be an assistant, that is what you always will be. When you are trained to be an indy provider, you are a different breed.



If eliminating AA's means less people receive anesthesia needs, the AANA couldn't care less, because it means they have a less an income and power threat.

It does not tho. Moreover, it never did.


AA's, however, are not running around claiming they are equal in ability to having the training of 4 years medical school, 4 years residency and 20,000+ clinical hours. They are willing to admit they have some limitations and do not have this notion medical school is a waste of money and knowledge, in the realm of anesthesia.

I have talked to AAs who would beg to differ. The difference is they have no choice but to be nice to the master so they dont get in trouble.

droopy1592
08-17-2009, 11:17 PM
But they don't claim it's equivalent. They claim it's better ...because of all their "pre-med" courses. Whatever. I took all the pre-med courses, too - as did many others on this board.
Same here. I originally took pre-reqs for PA school (it was the last program in GA for a PA Bachelors, and another program didn't require a Degree to get a masters that year- MCG) but after sitting through O-chem with a nurse that told me all about CRNAs, I then decided to go ahead and pay my dues in the ICU.

drnurse
08-17-2009, 11:43 PM
But they don't claim it's equivalent. They claim it's better ...because of all their "pre-med" courses. Whatever. I took all the pre-med courses, too - as did many others on this board.

This is a generalization; it is not the norm, but only your experience. I have heard AA's claiming their degree to be equal to a CRNA but NEVER heard an AA claiming that their degree is a superior degree to a CRNA. Rather, they believe themselves to be competent mid-levels, but they admit that they hold some limitations that a physician is more trained to deal with. The point is that AA's are here, and are here to stay. They will only grow in size in the future. Whether or not you want them here (or whether or not I do), or whether one thinks they are unnecessary, does not change this. Every anesthesia provider will have to work together in the upcoming 50 years to provide the best service. AA's serve a valuable niche, and their role should not be marginalized, based on politics.

rubyrn36
08-18-2009, 01:32 AM
This is such a futile discussion. What you don't seem to understand is that we do NOT need another anesthesia provider in this country. Nurse anesthetists can practice without supervision, but AA's can't. So CRNAs are simply more marketable, along with consistent data validating safe practice and competitive reimbursement.

CRNAs and AAs do not compete. In my mind, AAs are just another way for anesthesiologists to make money without having to do anesthesia.

PLEASE, if you are not a doctor or nurse, change your sign in name. Those of us who are doctors (of any kind) and nurses have worked hard to be able to use those designations. If you are not one, you are a fraud.

Jan Mannino, CRNA, JD (earned them both)



right as usual ....yoga

dontquit
08-18-2009, 07:06 AM
Jan,

I cannot agree with you more. You're always thought provoking, and right to the point. I appreciate your words of wisdom.

joeyz
08-18-2009, 07:13 AM
I dont believe at all that the "lazy doctor" idea doesnt exist. Im training a girl right now whos father is an MDA at a neighboring hospital. According to her, he has mentioned on several occasions that he loves CRNA's because he goes to work and makes 400k a year by sitting in the doctors lounge reading the news paper while they do all the work. She said that he was actually very pro-CRNA due to this fact.

drnurse
08-18-2009, 11:21 AM
sure, lazy doctors certainly may exist, but so does the CRNA who can't function in an independent setting and needs the backup of a physician.

Remember, when you have a doctor watching 3 cases, it is easy to think that they are just goofing around while a CRNA does all the work. But the reality is they have a ton of responsibility- if something goes wrong, they are accountable and the one in charge. And typically anethesiologists aren't making "4 times" a CRNA. Based on national salary averages, it is barely 2x (140K vs 280K). As many anesthesiologists feel, it is tougher when having to watch CRNA's than just performing your own cases, because when you do your own case-work you only have to be accountable to yoursself, and your own skills.

Gassy
08-18-2009, 11:47 AM
I dont believe at all that the "lazy doctor" idea doesnt exist. Im training a girl right now whos father is an MDA at a neighboring hospital. According to her, he has mentioned on several occasions that he loves CRNA's because he goes to work and makes 400k a year by sitting in the doctors lounge reading the news paper while they do all the work. She said that he was actually very pro-CRNA due to this fact.

And you believe everything you hear and read? I believe that Elvis is still alive and that Jacko just joined him in hiding. Last I heard they were in Cancun.

Sheesh. Is this the type of person who is being admitted to nurse anesthesia school? We should all be afraid. Very afraid.

ADMIN
08-18-2009, 11:59 AM
Gassy

You are clearly another troll. I have reviewed all of your previous posts and one thing is very clear, you are likely not an RN and certainly not pro your own profession if you are.

Instead of pretending you are and trying to add in little pro-AA anti-CRNA comments with every post, why dont you just fess up?

Either way, you will be summarily called on all of your BS at every turn here by people who actually have a clue.


And you believe everything you hear and read? I believe that Elvis is still alive and that Jacko just joined him in hiding. Last I heard they were in Cancun.

Sheesh. Is this the type of person who is being admitted to nurse anesthesia school? We should all be afraid. Very afraid.

MmacFN
08-18-2009, 12:01 PM
You are totally out of touch with reality.

Every post you make we debunk yet, amazingly, you continue to make a fool of yourself.

I guess you just cant fix stupid.


And you believe everything you hear and read? I believe that Elvis is still alive and that Jacko just joined him in hiding. Last I heard they were in Cancun.

Sheesh. Is this the type of person who is being admitted to nurse anesthesia school? We should all be afraid. Very afraid.

Eugenius
08-18-2009, 12:04 PM
Same here. I originally took pre-reqs for PA school (it was the last program in GA for a PA Bachelors, and another program didn't require a Degree to get a masters that year- MCG) but after sitting through O-chem with a nurse that told me all about CRNAs, I then decided to go ahead and pay my dues in the ICU.

I took all of the pre-medicine pre-req's to make myself a better CRNA and/or expand my horizons and did very well in them. They are not the 'end-all be-all'. They have expanded my knowledge on many general topics which have helped my understanding of medicine, especially physics and organic chemistry. They probably should be a pre-requisite for CRNA school even if it's nothing more than being competitive.

MmacFN
08-18-2009, 12:12 PM
I took em all and got into med school.

None of the pre med classes have helped me, in ANY way, as an RN or as a CRNA or in anesthesia school.

They are irrelevant.



I took all of the pre-medicine pre-req's to make myself a better CRNA and/or expand my horizons and did very well in them. They are not the 'end-all be-all'. They have expanded my knowledge on many general topics which have helped my understanding of medicine, especially physics and organic chemistry. They probably should be a pre-requisite for CRNA school even if it's nothing more than being competitive.

drnurse
08-18-2009, 01:12 PM
I took em all and got into med school.

None of the pre med classes have helped me, in ANY way, as an RN or as a CRNA or in anesthesia school.

They are irrelevant.

Agreed. Pre-med classes are irrelevant for anesthesia, and for any field of medicine (I mean, those classes are just the intro of the intro). All of introductory biology is reviewed in two days in medical school. The rest (with the exception of some limited chemistry and bio-organic chemistry) is simply disregarded. But medical school classes and curriculum are definitely applicable to ALL specialties of medicine, in different ways, including anesthesia. They teach you to think more critically and not mechanically, and it is easier to piece things together w/ the whole picture of the human body. Anesthesiology residents would flunk out and fail miserably, without a medical degree and some of the knowledge they learned from medical school. Regardless of politics, the importance of medical school to anesthesia is something that 99.99% of anesthesiologists truly believe in, and it has nothing to do w/ money or power issues.

BTW, mike med school did you get into? Why did you go through all the trouble of doing the two years prerequisites, taking MCATs, doing all the clinical volunteering etc, and then not end up choosing medicine? And had you gone into medicine would you have picked anesthesiology? Or did you decide to be a CRNA way after turning down med school...

MmacFN
08-18-2009, 01:26 PM
Why did you go through all the trouble of doing the two years prerequisites, taking MCATs, doing all the clinical volunteering etc, and then not end up choosing medicine? And had you gone into medicine would you have picked anesthesiology? Or did you decide to be a CRNA way after turning down med school...

Well, for a couple reasons.

For awhile I knew I wanted to do something more but could not decide on what that was. I did not know what CRNAs were (since im from canada). That being the case I went ahead with plans to goto med school. I actually discovered CRNA school AFTER doing everything for med school. It was not long after getting accepted to med school i decided on the CRNA route. At the time, I thought CRNAs made around 100K but worked independently (i didnt know about ACT practices). While the money was not anymore than I was making as a flight RN and with my education company, the autonomy was in line with what i did in the helicopter. It was only later i learned about restrictive practice models and the higher compensation.

Had I gone into medicine it is hard to say what I would have chosen, but i can say it would not likely have been anesthesia. It was not even on my radar. However, as i am sure you know, most med students change their minds about what they want to specialize in many times throughout med school. So who knows? Initially, I was interested in emergency medicine.

So why didnt I go?

Well I guess the main reason is that I realized I did not want to be a physician. I have all the respect in the world for those who goto med school, I applaud you for making that decision and having the moxie to graduate. I also have respect for residents (even the newbies) and have always taken it upon myself to call them "Dr." even when they wanted me to call them by their first names. For me, that just seemed like a nice thing to do and they deserved it.

Another of the main reasons were all my physician buddies. These same guys who wrote me reference letters for med school also sat me down and told me not to do it. They were not happy, they didnt feel it was worth it and would never do it again. These were not random ppl i worked with, these were some of my best friends (and still are today). One happened to be an MDA who initially suggested CRNA school and an indy practice etc. Clearly, he isnt political (and is still not today) but just wanted to give his buddy his best advice.

In anycase, that is my story. So while we may be politically opposite because that is how it is, do not think for a second I do not respect your education and hard work, I do. I think we all do. We just ask others to do the same.

drnurse
08-18-2009, 01:48 PM
Very interesting story. Sounds pretty non-traditional. And I totally respect your story and CRNA's as a profession, despite different politics and views about the two professions. All of the bad blood physicians have comes directly from the AANA leadership. FYI, I think you (and some others on here) think I am Coastie from SDN (probably based on the fact that there is a parallel thread on SDN quoting excerpts of my posts here, which I can assure you I have nothing to do w/) but I will admit that I am not him.

AAMan
08-18-2009, 02:12 PM
I took em all and got into med school.

None of the pre med classes have helped me, in ANY way, as an RN or as a CRNA or in anesthesia school.

They are irrelevant.


Wanted to stay away but just cant resist.
LOL. That's one of the funniest yet dumbest thing I've read on this site. Dude I get you want to be as anti AA/ASA as possible but come on.

MmacFN
08-18-2009, 07:10 PM
Yes and one of your masters (an MD) just agreed with me.

Now who's the fool?

You are out of yer depth here.


Wanted to stay away but just cant resist.
LOL. That's one of the funniest yet dumbest thing I've read on this site. Dude I get you want to be as anti AA/ASA as possible but come on.

ethernaut
08-18-2009, 07:19 PM
sure, lazy doctors certainly may exist, but so does the CRNA who can't function in an independent setting and needs the backup of a physician.

Remember, when you have a doctor watching 3 cases, it is easy to think that they are just goofing around while a CRNA does all the work. But the reality is they have a ton of responsibility- if something goes wrong, they are accountable and the one in charge. And typically anethesiologists aren't making "4 times" a CRNA. Based on national salary averages, it is barely 2x (140K vs 280K). As many anesthesiologists feel, it is tougher when having to watch CRNA's than just performing your own cases, because when you do your own case-work you only have to be accountable to yoursself, and your own skills.
i have heard from, and work with, docs who say this very thing. i can believe it. in my experiences, it's usually the newer docs more so than the many years seasoned ones. i can relate when precepting first semester/first year SRNAs. i'm more mentally exhausted some times than if i did 20 GI cases.

beekahx4
08-18-2009, 07:46 PM
sure, lazy doctors certainly may exist, but so does the CRNA who can't function in an independent setting and needs the backup of a physician.

Remember, when you have a doctor watching 3 cases, it is easy to think that they are just goofing around while a CRNA does all the work. But the reality is they have a ton of responsibility- if something goes wrong, they are accountable and the one in charge. And typically anethesiologists aren't making "4 times" a CRNA. Based on national salary averages, it is barely 2x (140K vs 280K). As many anesthesiologists feel, it is tougher when having to watch CRNA's than just performing your own cases, because when you do your own case-work you only have to be accountable to yoursself, and your own skills.


But the responsibility still resides with the person doing the case. If something goes wrong, the CRNA will get placed with all the blame. The MDA will say that they were not in the room and they did not agree with the way the CRNA treated the pt. They will try to place all blame on the CRNA and they will get away with it also.

We do take blame and responsibility for our actions in the OR. The money should rightly compensate our actions and responsibilities.

Would you rather stay in one room or managing 4 rooms with CRNAs that know what they are doing? Maybe 1 out of 4 doesn't always know what they are doing so you are stuck in that room working instead of relieving breaks. I don't know how you practice.

Give me the law suits where MDA doesn't shift blame to the CRNA. You are still making double/triple the amount we are. I do not think that you don't have a ton of responsibility, but we share that responsibility. That's what makes us different from an AA. They can shift all blame to you while we can't.

I do respect the # of hours and sacrifice that a MD does. Please do not disregard the sacrifice many of us do to get where we are. Where I was trained as an ICU nurse, we were expected to function as a 3rd year resident in our units. We questioned the resident/fellow/intensivist if we didn't agree with their plan of action and had a reason for the questioning.

Most of the CRNA's that you find incompetent will not be found on this website. This is not the norm.

Range
08-18-2009, 07:50 PM
You are totally out of touch with reality.

Every post you make we debunk yet, amazingly, you continue to make a fool of yourself.

I guess you just cant fix stupid.

You nailed it!!!

Ali

ethernaut
08-18-2009, 07:51 PM
But the responsibility still resides with the person doing the case. If something goes wrong, the CRNA will get placed with all the blame. The MDA will say that they were not in the room and they did not agree with the way the CRNA treated the pt. They will try to place all blame on the CRNA and they will get away with it also.

We do take blame and responsibility for our actions in the OR. The money should rightly compensate our actions and responsibilities.

Would you rather stay in one room or managing 4 rooms with CRNAs that know what they are doing? Maybe 1 out of 4 doesn't always know what they are doing so you are stuck in that room working instead of relieving breaks. I don't know how you practice.

Give me the law suits where MDA doesn't shift blame to the CRNA. You are still making double/triple the amount we are. I do not think that you don't have a ton of responsibility, but we share that responsibility. That's what makes us different from an AA. They can shift all blame to you while we can't.

I do respect the # of hours and sacrifice that a MD does. Please do not disregard the sacrifice many of us do to get where we are. Where I was trained as an ICU nurse, we were expected to function as a 3rd year resident in our units. We questioned the resident/fellow/intensivist if we didn't agree with their plan of action and had a reason for the questioning.

Most of the CRNA's that you find incompetent will not be found on this website. This is not the norm.
:pound:
c'mon dude.

deepz
08-18-2009, 10:45 PM
Probably beekahx4 intended to say supervise Third Years in the interest of patient safety.


:nurse: :nurse: :nurse: :nurse:

dontquit
08-19-2009, 07:37 AM
But the responsibility still resides with the person doing the case. If something goes wrong, the CRNA will get placed with all the blame. The MDA will say that they were not in the room and they did not agree with the way the CRNA treated the pt. They will try to place all blame on the CRNA and they will get away with it also.

We do take blame and responsibility for our actions in the OR. The money should rightly compensate our actions and responsibilities.

Would you rather stay in one room or managing 4 rooms with CRNAs that know what they are doing? Maybe 1 out of 4 doesn't always know what they are doing so you are stuck in that room working instead of relieving breaks. I don't know how you practice.

Give me the law suits where MDA doesn't shift blame to the CRNA. You are still making double/triple the amount we are. I do not think that you don't have a ton of responsibility, but we share that responsibility. That's what makes us different from an AA. They can shift all blame to you while we can't.

I do respect the # of hours and sacrifice that a MD does. Please do not disregard the sacrifice many of us do to get where we are. Where I was trained as an ICU nurse, we were expected to function as a 3rd year resident in our units. We questioned the resident/fellow/intensivist if we didn't agree with their plan of action and had a reason for the questioning.

Most of the CRNA's that you find incompetent will not be found on this website. This is not the norm.
Have you ever heard of the legal term "Respondeat superior" (Captain of the ship)

stanman1968
08-19-2009, 07:41 AM
Captain of the ship is as dead as michael jackson

dontquit
08-19-2009, 08:15 AM
You may be right..Vicarious liability may be the better term....
Read on

http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2404

stanman1968
08-19-2009, 08:26 AM
, the responsibility of any third party that had the "right, ability or duty to control" the activities of a violator.

This vicarious liabilty? The one in which I as the CRNA can be named for allowing a surgeon to perform in an unsafe manner. Dude everyone falls under this, has nothing to with supervision the anesthesiologist IS NOT RESPONSIBLE FOR YOUR ACTIONS, if you jack it up it is your ass on the line not his.

MmacFN
08-19-2009, 08:59 AM
hey dontquit


The surgeons liability is the same with a CRNA or MDA. Captain of the ship doctrine no longer exists.

As for direct surgeon liability, the only time a surgeon takes liability for the CRNA is if the 'take control' of the anesthetic. However, this same legal tenent exist if it was an MDA. So if the surgeon says to give KCl and either the CRNA or MDA said "ok" and did it when not indicated both the surgeon and the anesthesia provider is liable.

Vicarous liability exist for everyone. Something goes wrong in the case and the lawyer takes a shotgun approach to the law and names EVERYONE. Surgeon, hospital, anesthesia, OR nurses etc. Then people are summarily dropped as liability is not established.


You may be right..Vicarious liability may be the better term....
Read on

http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2404