Background: As I've previously described, I work in an autonomous practice where I work independently and consult with others as needed. I work with some great anesthesiologists and enjoy their input. We are collegial and respectful. As a recent grad, I don't hesitate to seek the input of others.

I knew the question would come eventually. "You're a what? A nurse anesthetist? I'd prefer an MD to do my anesthesia." I've tried to be prepared for this situation, because it's my due diligence to inform and educate the public about nurse anesthetists and our role in anesthesia delivery in our country. I had still been thinking about the answer to give, when I ran into this situation.

My patient was a 6'2'', nearly 300 lbs. Having a urologic procedure. Straight forward case. In my usual fashion, I began my interview by unambiguously stating "I am a nurse anesthetist and I will be giving your anesthesia today." I do this to ensure there is no confusion about who I am or what I do. I don't want anesthesiologists to get credit for my work, nor would I want to withhold credit from them when they make contributions to my practice. For this reason I ensure patients know the difference, and I refrain from stating things such as, "I'm from the anesthesia department". With this patient, I saw his eyes immediately look at my badge - he cocked his head, his eyebrows came together slightly - he obviously noticed "nurse anesthetist".

"Well, a nurse anesthetist couldn't intubate me once for an ablation - I had stopped breathing - they had to cancel the procedure, they had to call in lots of help. My family MD told me to never use one [a nurse anesthetist] again, to only use an MD."

To which I responded, without hesitation:

"Well, clearly your family doctor doesn't know what he's talking about when it comes to anesthesia. I could share 10 horror stories about every type of provider - nurse - doctor - surgeon - and so on. What matters is an individual's skill and ability being matched to specific [clinical] situation.

[Smiling] Now, any other problems with anesthesia?"

I probably could have chosen my words differently, but it was my immediate, gut-level response. My H&P continued without issue and I explained my plan for his procedure. The anesthetic and procedure were uneventful.

I sense this to be a unique and sensitive opportunity, so I spoke the family again afterwards. I encouraged them to continue to always voice any concerns about their providers, and encouraged them to find different providers (regardless of training or background) if they didn't feel comfortable and confident. They were appreciative of my efforts to communicate openly with them.

Ironically, CRNAs had done his anesthesia for his previous 3 procedures without him even being aware of them being nurse anesthetists.

To this man, CRNAs were a secret while doing quality anesthesia, but remembered CRNAs distinctly during a bad experience. Experiences like this one add up, and I hope he remembers me, a nurse anesthetist, for giving him a quality anesthetic.


Anyone else have similar stories to share?

JR