Is the Pain Worth it?
ByIts always nice to hear from former classmates and today was no exception. Mel moved with her husband out to Florida after graduation and is now working and living it up in the Sun State with her husband. While going through the “educational process” of becoming a CRNA here at the University of Southern California, all of the difficulties and seemingly unending struggles both in the classroom and in clinical rotations tend to dull the enthusiasm a bit.
Mel never lost here enthusiasm through loss of sleep and all the struggles SRNA’s go through.
Here is her letter to Dr. Michele Gold the program director at USC that puts it all in perspective:
Hi Dr Gold,
I just needed to drop you a quick line to Thank You and all of my preceptors and teachers at USC. As you know, I am out here in Florida, and it has been a real eye-opener as to the superior education and training that I have received at USC compared to (unfortunately) a lot of new graduates and students that I have come in contact with. It has made me appreciate my “painful” two years even more….and I never thought Id say that Hope all is well with you and the program, we are loving our new life in Florida.
Sincerely,
Mel
Its a good thing for current students and candidates to any nurse anesthesia program to hear the stories of others however brief. During our time in “The Program” at USC Mel and I did struggle more than a few times with what seemed at the time to be unreasonable expectations. To say that its tough to become a CRNA is a true statement. Think about it. Would you want some lazy inattentive provider giving anesthesia to your grandmother? Wouldn’t you want the brightest most vigilant anesthetist with the experience to handle any difficulty during the anesthetic to be at the head of the bed. That’s what all anesthesia providers strive for whether physician or nurse anesthetist.
A case in point. Yesterday afternoon a gun shot wound victim was “RB’d” to the OR. Three CRNA’s and a first year resident were on hand to start the case that very quickly required all the standard lines, arterial central and multiple large peripheral IV’s. We began the case immediately when the guy arrived with a Level One rapid infuser in the room. We ended the case the two Level One’s going for volume resuscitation, I was giving a lot of blood products. After an hour and a half the surgeons were mopping up and the attending anesthesiologist walked back in the room and smiled saying what a great job we all had done. Thankfully these kind of cases are not common out in the community. But here at the largest level one trauma center in Los Angele’s we see a variety of crazy things from massive trauma from train wrecks, car crashes and of course the “knife and gun” club action.
I am glad that the training we received has prepared us to handle these as well as the routine.
I love the comment above: Wouldn’t you want the brightest most vigilant anesthetist ? No, I want an anesthesiologist (MD). not a nurse (CRNA). I just had anesthesia from an all MD practice and none of them would consent to CRNA-provided anesthesia despite all of the cheerleading. When BC/BS told me that a CRNA would cost the same as an anesthesiologist, my choice was simple. My surgeon agreed: get an anesthesiologist; that’s who the CRNA’s call if anything goes wrong..
Sue,
I believe you are totally wrong about your feelings. The “Brightest and most vigilant” anesthesia provider is not necessarily an MD nor is it necessarily a nurse anesthetist. It just depends on the provider.
Statistics show that there is NO difference between the two groups as a whole as far as safety outcome criteria is concerned. All I know is that NO one is more vigilant or “brighter” than me! Maybe I am a little prejudiced but no one can give a better anesthetic for any procedure than a nurse anesthetist. I stand by that statement. (Tongue in Cheek OK)
I have total respect for my anesthesia MD friends that I work with, I have bailed them out countless times. To be honest, we have bailed each other out many times for which I am grateful.
Sue, you sound sincere if misguided. Your comment sounds to me to be politically motivated and not at all about a reflection on the original topic of the post but I allowed the comment anyway. It will show the desperation of some groups and their paranoia. Nurse anesthetists are used to this.
It is with great pleasure that I work in a team environment with MD’s but I do not in any respect think that they are more than half of the equation.
DG
Sue
I speak from a bit of an outsider’s prospective. I am hoping to get into CRNA school, but I work with a plastic surgeon and we do surgeries with many anesthesiologists from a specific practice. Every one of them that I have spoken to have very clearly stated that they would have no problem working with CRNA’s. They seem to believe the skill level is very much the same and would feel VERY comfortable with placing the care of their patients in the hands of a well trained CRNA. The only issue is politics.
Sue, do you understand why an MD would be against an RN doing something that they do just as well as they do it? Perhaps the fact that a CRNA is paid less but does the same thing brings up concerns for the stability of their jobs. I’m sure you would do everything you could to keep from loosing work.
The botom line is this. Political opinions do not have anything to do with skill level. Please remember that.
I totally agree with Sue’s original comments. I have nothing against CRNA’s, if a patient wants to receive anesthesia from a nurse (CRNA) that’s fine with me. I do not and don’t believe that a CRNA will ever equal an anesthesiologist, but I believe that they have a role (closely supervised). I was attended to by a capable CRNA at a hospital while serving in the military; I was severely burned while my aircraft was being refuled and I was glad to have the CRNA while I underwent lengthly debridements and skin grafts. CRNA’s were all the military had, but I have to say that my CRNA did a great job. She kept my screaming to a minimum, so I’m grateful. But back in civilian life, I’ll choose an anesthesiologist. My wife is a physician and agrees that CRNA’s are useful when supervised. I can’t see where a CRNA’s salary is relevant to this discussion; for me it’s all about patient safety. My salary is in excess of most physicians and (thankfully) I can see any practitioner that I want to see. My choice is an anesthesiologist not a CRNA, but that doesn’t mean that I think that nurses are unqualified for advanced roles. My PCP (I guess PCNP) is a nurse practitioner and she’s as sharp a any doctor…..I just don’t think that anesthesia is a safe arena for CRNA’s to practice without supervision.
There is NO EVIDENCE that an MD anesthesia provider is safer than a Nurse anesthetist. Don’t go around spouting nonsense. If you feel more comfortable with an anesthesiologist that is fine but do not tell me or any others that nurse anesthetists are not safe. You are totally wrong and the courts have supported the evidence. If you want to see real evidence that CRNA’s results are as good as any provider check this study.
I being an Anesthesiologist myself, agree that there is no difference as such with regards to safety between an CRNA and a n anesthetist. We all need to understand that both play an important role in providing better and safe health care. If there would have been any issues with safety, then which surgeon would choose a CRNA. The reason why CRNA’s are called is that they are equivalent in providing safe anesthesia and emergency services.
There are just some people who are so uneducated that they think certain titles, i.e. NURSE anesthetist, are important. By the way Gary, your wife is a physician, but IS SHE AN ANESTHESIOLOGIST? No? Well, then she probably wouldn’t know much about being an anesthesiologist OR a CRNA. Some people are just ignorant (edit). Oh and by the way, you probably think that if something costs more than it must be better. Ignorant (expletive edit).
Thank you sir for being a voice of reason is a sea of confusion. There is NO difference with regards to safety between a CRNA and an anesthesiologist. I totally agree. Now is there a difference between an anesthesiologist and a nurse anesthetist, yes. Discovering the differences and putting them to the best use for the patient is what is most important.
I did an AAA today and consulted with an anesthesiologist that does lots of these cases. This was very useful to me and to the surgical outcome for the patient. The bottom line in my opinion is, there is room for all of us. We just have to find our place. And that is what all the commotion is about. What is the roll that we are to play.
CRNA’s have a role, as nurses who should be supervised. Nothing more, nothing less. Nobody who is being honest with themselves would equate nursing school (crna) with med school. Dave, you are entitled to your opinion but it makes no sense. I’m glad that my hospital will never allow “solo” crna practice. “anesthesia general” is obviously a nurse. sorry, my opinion of crna just dropped a huge notch; and in my hospital, that means something to a lot of people.
Anes@yahoo.com,
Thank you for your comment at nurseanesthetist.org. I think you may have mistaken me for someone else. I have never advocated for “solo” practice. In fact I work in a team anesthesia group and find it very rewarding. Perhaps you have mistaken my passion and advocacy when someone says that nurse anesthetists are not “safe”. To that comment I will fight to the last drop. If you say that we can work together and take care of patients I will support you. If you say that I am not safe to practice anesthesia I will object vehemently. I really am a nice person you know.
By the way, Your email is FAKE. So what does that say about you?
David Godden
I do not care if it would be a CRNA or an MD anesthesiologist as long as they care about my life. I honestly did not know until I had teeth extracted there was a CRNA. However, when I ask her personally about being safer with an actual anesthesiologist she told me this “I have children at home, and so do you. I could not imagine going home to my children knowing I caused someones children to lose their mother today, therefore I could not do what I do if I was not confident with knowing you would wake up and go on with your life after I did my job”. That meant a lot to me and I trusted her because of that. I’m sure they could make a mistake but couldn’t an anesthesiologist make one as well?
if a nurse wants to do a physician’s job, she/he should go to med school, not “cut short” doing a 3-5 year course. Nurses should do what they are supposed to to, the same for MDs.
What’s next? nurses should be called doctors and write MD. before their names?
Hmmm, I could write a whole post just on this one comment. Nancy, I refer you to this article which could partially answer your question if you are interested in one.
“The Future of Nursing: Leading Change and Advancing Health” a report by the IOC (Institute of Medicine) found here:
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12956
Quick situation in the OR. The patient was coding and we needed fast intubation. The anesthesiologist freaked out really bad and started to yell,” call a doctor!” A CRNA came in and intubated the patient in a matter of seconds. This was too funny! It’s not the intials you get after your name, it’s the experience you have and what you can do in a crisis situation. Nothing bad against the MDs, I’m sure they have their share of jokes about CRNAs as well.
To Nancy, Gary and Sue, I have to say the attempt you’ve made to discredit CRNAs was definitely in vain. If you’ve ever received anesthesia whether it was in an OR at the best hospital in the country, or even at the orthodontists office, there is a pretty high chance that a CRNA put you under. In fact you can go to the biggest and best hospital in the United States and you will find anesthesia care teams that consist of CRNAS, AAs, and at most 4 anesthesiologists, and that is the biggest hospital in the United States.
Also there are state laws that allow CRNAs to perform without the supervision of an anesthesiologist. I myself am CRNA and before I even start to try to sway anyones opinion on this matter. It would only be sensible to inform them of the history of anesthesia in the US. More than a generation and a half ago nurses were the only medical professionals that were competent in anesthesia. As of now more than half of the anesthetics in the US are administered by Nurse anesthetists. And funny thing is right here Nancy Gary and Sue CRNAs have been given the right by mandated laws to practice with autonomy no matter the setting, OR, ICU, ER. Looking at this from an International perspective the laws that govern CRNAs the US are by far the strictest. The only state that mandates an MD be present during CRNA performing anesthesia is Georgia, and the MD doesn’t even have to be an anesthesiologist. You three buffoons need to understand that CRNAs deal with very complicated life or death situations that you should appreciate much less try and discredit. For Nancy Gary and Sue, it is obvious none of you know what your talking about, so please do everyone a huge favor and keep your hilarious opinions to yourselves.
There are good nurses and bad nurses as well as good and bad doctors. Just pray that you end up in the hands of the good ones and not the bad ones. Good nurses are better than bad doctors.
Interesting blogging here. I just had to comment. First of all, Who gave Michael Jackson Propofol?? An M.D. thats who. Propofol, a drug that should only be given in hospital type environment, where the patients vital signs are continuously monitored, where there is a CRASH CART, and INTUBATION TRAY, and AMBU BAG MASK AND SUCTION!! Not in the HOME! Ok heres my background. . . 7.5yr RN in PEDIATRIC ICU. Ive given lots of different sedatives, including propofol. Ive managed drips. Ive managed post open heart surguries on tiny babys, severe head trauma from car accidents, weird airways and congenital abnormalities. I can tell you many times when I was the one giving orders to the M.D.s, I think we should give the patient more sedation, more volume, intubate. Ive helped code patients, while barking out what drugs to draw up and what doses and how many ML to draw up, right on the top of my head. Because I am experienced and I know! So, here I am applying to CRNA school, so I can still perform handson skills on patients, except with school, I will not only know the dosages, but the chemical properties of these drugs, and the properties of anesthetic gas and how to give it safely. Why would I waste all my hard work and dedication. . . The purpose of advancing my degree is to be “specialized”. You be the judge, I think I have plenty of experience working under “MD” as I actually give these drugs, monitor the patients, and think critically already. And its not about just doing what the MD tells you to do, its also thinking about is this right for the patients safety, the right drug, the right route, the right patient, right dose, right vital signs and situation. I would be stopped short of my career if I dont advance now. Im ready to become a CRNA!!! Because I know I can be vigilant. . . trusted. . .. dedicated to patient safety! I already practice this as an RN
@Dave:
Is there a difference between CRNA and an anesthesiologist for simple cases? Nope. Is there a difference for an ASA 4-5 case- you bet! The training a CRNA receives IS NOT THE SAME as that a physician receives and to convince one otherwise would be moronic. CRNAs are a great asset to an anesthesiology team but please stop citing your BS “research” about equality of MD VS CRNA published by your own lobbying group AASA- seriously what a joke! How can you even claim you are a creditable resource with this crap. Also I want to clarify for anyone reading this board- the training a CRNA receives does not equal that of a physician- Anesthesiologists receive training in other aspects of medicine including ICU care, pain management, sleep medicine, cardiac medicine etc. While you may not want to admit it, CRNA does not = anesthesiologist; ICU experience does not = anesthesiology residency trained heavy in ICU management; participating in a TEE does not = anesthesiology cardiac fellowship. I am not an anesthesiologist or a physician but some of the things implied from posts here are scary.
Phishman,
Thank you for your comments. Of course there is a difference between nurse anesthesia providers and physician anesthesia providers. The MD’s have a very large scope of practice in peri-operative medicine which the nurse anesthetists do not have. Totally agreed.
All I have been defending here is the idea that nurse anesthetists are safe, period. No mention of solo practice, OK.
I am closing this crazy commenting on this issue. It has nothing to do with the purpose of this web site. The intent here is to encourage nurses to pursue anesthesia education and show them the way. Conflicts with our physician friends have no part of that.
David,
Thank you so much for your intelligent and insightful responses. Its nurses such as yourself that make me proud to wear the RN title on my chest.
With that being said, I think the bigger picture is being missed here. Healthcare will not discriminate between MD or RN when it comes to administration of anesthesia; an organization will look at safety and costs to determine who performs this role. As David has already pointed out through use of a respected study, the safety of anesthesia administration is the same whether through an MD or CRNA (as an earlier post argues, this study was not performed by the CRNA governing body AANA, only used to an article that sheds light on its findings, like countless others before it. Likewise, if the study had proven that CRNAs did in fact have lower safety outcomes, it would have been printed in a MEDICAL journal no doubt, but I digress).
The other very important issue is cost, and lets be honest, CRNAs are cheaper. According to salary.com, CRNAs on average make almost 150,000 less per year than anesthesiologists.
Paying 150,000 less a year PER anesthesia role with the same outcomes? You’re going to be hard pressed to find any institution not willing to make that deal.
Cardiac Surgeon here, here’s my two cents:
First off, I work with CRNA, I enjoy working with CRNAs, and have nothing against them. I would just like to comment on these “studies” of safety that people keep quoting.
The studies that quote “no difference” between outcomes between anesthesiologist and CRNA makes no sense to me. The quality of cases are very different between these two groups. For instance, yes there are CRNAs and MDs doing cardiac surgery cases that can be compared, however, there is probably no comparison between a CRNA and MD in a cardiac case with severe mitral valve regurgitation complicated by endocarditis requiring TEE. Simply because no group in their right mind or surgeon would have a CRNA manage that case without extremely close supervision by a MD.
If I did a study between a PA vs. a 4th year surgical resident assisting a lap cholecystectomy and found that the surgical outcomes are the same, I would not generalize it as “its just as safe, so why hire a surgeon when you can have a PA for cheaper” If for some reason a vital structure is hit during this procedure, the 4th year surgical resident would have a far better understanding of what to do to keep the patient alive. And this is the main difference. It’s important to have the extra training when things go wrong. This is what makes it “safer” to have someone better trained.
Similar to Anesthesia, when things go wrong, the CRNA calls for the Anesthesiologist.
Again, my goal here is to not “put down” any one field. I just want to clarify how wrong a lot of people interpret various studies and make presumptions from them.
Chris,
Thank you for your comments. I agree with everything you say pretty much. No arguments from me. Excluding the cardiac room I will say that I would put a seasoned CRNA in any room and have no problem trusting they would do a good and safe job.
Advanced training is really important and I think that the physicians that do fellowships are especially qualified in their fields. I look to these for advice all the time and backup when needed.
Again, thank you for taking the time to comment. The polictics of health care is really getting under peoples hide. Me, I just want to take care of patients and be a “Team” memeber.
David Godden
David, I detect some misgivings on your part when it comes to solo CRNA Providers. Be careful friend, I and many others have been working solo for years. For the last 12 years I have been the sole provider in our rural facility. I have no problem doing so, and the literature supports the safe care we give everyday. Not just ACT settings, but ALL settings.
I have been a CRNA for about two years, i live in a small area and we only have 2 CRNA’s and no anesthesiologist, and our patients seem to make it just fine!!