What is a “Militant” Nurse Anesthetist?
On many occasions I have seen Anesthesiologist refer to “militant” Nurse Anesthetists (CRNAs) in online forums and even at conferences. I often wonder what that means and why someone would use the term “militant”.
Militant is defined as:
“combative and aggressive in support of a political or social cause, and typically favoring extreme, violent, or confrontational methods.”
I thought this was an interesting definition to assign to the American Association of Nurse Anesthetists (AANA) and its members. There is no doubt that the AANA fights for its members and engages in advocacy on the professions behalf, but does that constitute ‘militant’ behavior? I think it is worth it to look at what the AANA has been doing so I reviewed their actions and assessed their ‘militancy’ below.
1) The AANA advocates for CRNAs to work to full scope of practice based on their education. The AANA bases this on a number of studies showing CRNA only practice provides the same quality of care with equivalent safety records compared to Anesthesiologists working independently. They also advocate this as a way to decrease costs to tax payers as CRNAs are trained faster and the economic cost of educating a CRNA is ¼ that of an Anesthesiologist. Advocating to allow people to work to the full extent of their training and license which expands services to all patients including rural areas which would otherwise have none at a lower cost to the public does not appear to constitute “militant”.
2) The AANA has advocated that CRNAs get paid the same as Anesthesiologist when the same service is rendered. This seems to be common sense. In no other business would someone expect to be paid less who is equally qualified. Again this does not seem to constitute ‘militant’ behavior.
3) The AANA has fought against the ASA when they have tried to limit, restrict or otherwise control the practice of Nurse Anesthesia on a state and federal level. They do this in order to maintain control of the practice of anesthesia and thereby the revenue it commands which in and of itself appears anti competitive. This does not appear to meet the definition of “militant” by the AANA.
4) The AANA has defended against the ASA stating that CRNAs are not “safe” without an Anesthesiologist backing them up. Though this has been clearly debunked by all available evidence including the most recent Cochrane collaboration article, the ASA still continues to utilize fear tactics in legislative and public arenas to promote their self serving agenda. Defending against lies, mistruths and deception certainly does not constitute ‘militant’ but promulgating them certainly does.
5) The AANA and it’s state associations have repeatedly defended against the ASA and its state chapters attempting to promote hospital policies which limit how CRNAs can practice. Specifically, the ASA wants to see all CRNAs under the thumb of an Anesthesiologist. Devoid of evidence for their position they continue to use their long tradition of “evidence by proclamation” in their attempts to restrict trade and limit or eliminate competition. If the ASA really believed that CRNAs were an inferior product to Anesthesiologists then wouldn’t they want to simply compete in the market? One would assume they would stop trying to limit CRNAs and simply let the market decide. This is not what they do and so the AANA and its state affiliates have to fight these battles. This does not appear to meet the criteria for militant behavior by the AANA.
These are just some of the most common examples of where the AANA and Nurse Anesthetists are cited as being “militant” by the ASA. If defending my right to compete in the market place, defending my profession against mistruths and deception, expecting to work to the full scope of my training, fighting to get paid the same for the same service and fighting to keep a competing entity from legislating their agenda to control my profession and income is militant, well then I guess I am a “Militant” CRNA and I am proud of it.
As Inigo Montoya in the Princess Bride so eloquently stated and clearly applies in this instance to the ASA and its members:
"You Keep Using That Word, I Do Not Think It Means What You Think It Means"
The references for these statements can be found here: http://www.future-of-anesthesia-care...m/research.php